Advanced Security Concepts, Inc.

TRAINING ACADEMY
Course Enrollment

Executive Protection Fundamentals Course

* required

First Name: *	Mailing Address: *	Home Phone: *

Middle Name:	City: *	Work Phone: *

Last Name: *	State: *	Fax:

LEA Agency/Military Unit	Zip Code: *	Email Address: *

Rank:		Confirm Email: *

Requested Course (Tuition Must be Paid in Full with Registration) *

Course Date: (MM/DD/YYYY) *
/ /

I will abide by any and all safety procedures required by ASC and I agree upon my arrival, to complete, sign a “Release and Indemnificaiton Agreement” releasing ASC from liability for any injury I may sustain or cause during my training.

I hereby state that I am not a convicted felon, or otherwise forbidden by law to own, possess, or train with firearms, and that I am over the age of 21.

Student Signature: (Print your full name) *

Date: *

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