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Name: Date of Birth:
Street/PO: City/Town:
State:Zip:Email:
Telephone (H)(W):(C):
Course Name:Date:Fee:
Previous Formal Firearms Training:
Reason(s) for owning a firearm (Personal Protection, Target Shooting etc...):
Firearm Make to be used on range?:Model?:
Caliber?:
Have you ever been convicted of a felony?:
Have you ever been convicted of domestic violence?:
Is there a protection order in force against you?:
Where did you hear about us?
Explain your handgun experience and provide your NRA Membership Number if Applicable:
Applicants Signature:Date:
Mail / Submit with course fee to:
Maine CWP Training
Mr. Paul J. Mattson
101 Main St.
Harrison, ME 04040
You can also pay online and or (MAIL ONLY PAGE TWO) of your signed application if you choose.
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