Northeast Trading Co., Inc.

Commonwealth of Massachusetts Department of State Police

Basic Firearms Safety Certificate Sign Up Sheet.

Date ___/___/____

_____ NRA Basic Firearm Class   $99.00

_____ ________________________ $_____

Name: First __________________________                       Phone Number: ________________

            Last __________________________

            Suffix (e.g., Jr, III) ______________

Street: _______________________________

City: _______________________________

State: __________________ Zip Code: ________

Date of Birth ____/____/_____

Have you had any previous firearms experience? ____ Yes No ____

If Yes, can you give a brief description of your training: ___________________________________________

How did you hear of this event: ____________________________Comments:__________________________