Street/PO:      City/Town:

State:Zip:Email:

Telephone (H):(W):(C):

Course Name:Date: Fee:

Previous Formal Firearms Course 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?:

Briefly explain your handgun experience:

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 (MAIL ONLY PAGE TWO) of your signed application if you choose.