<% ' FP_ASP ASP Automatically generated by a FrontPage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(0) Dim arFormDBFields0(0) Dim arFormValues0(0) FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close FP_FormConfirmation "text/html; charset=windows-1252",_ "Form Confirmation",_ "Thank you for submitting the following information:",_ "Application.htm",_ "Return to the form." End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> APPLICATION

HOME     CURRICULUM     STORE

APPLICATION

 PLEASE COMPLETE,  MAIL, FAX OR E-MAIL THIS APPLICATION FORM AND APPROPRIATE INFORMATION TO:

Close Quarters Battle Institute - Bishop Ranch - 2603 Camino Ramon, Suite 200 - San Ramon, California 94583 

 Main Line: (925) 242-2558 - FAX : (888) 893-8521 

Email: application@cqbinstitute.com

REGISTRATION:     (Select Only One)

Law Enforcement Officer

    Driverís License 

    Law Enforcement Identification

  Active Duty Military

    Driverís License

    Military Identification

  Reserve Military

    Driverís License

    Military Identification

  Private Citizen

    Driverís License  

    Records Check from local police agency

 

CONTACT INFORMATION:   (Person Attending Training)

 

First Name
Last Name
Middle Initial
 Job Title
Agency/Unit/Organization/Company
Purchase Order Number (PO)   Required if Agency is paying by check or with terms.
Address  Use home address or agency/unit address.
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

COURSE SELECTION:    (Select appropriate course and date from list)

                       

 

 

 

WAIVER STATEMENT:     (Initial all boxes)

 

 I understand that the credentials enclosed meet the requirements as outlined by Close Quarters Battle Institute, Inc., and that I understand prior to the commencement of training I must identify myself as the same person certified in my application. I understand that I must be at least 18 years old to submit this application; that I am not a convicted felon; that I am not prohibited from the possession or ownership of a firearm in accordance with all local, state and federal firearms laws.

 

I understand that I am not in violation of the 1997 Lautenberg Act , which bans shipment, transport, ownership and use of guns or ammunition by individuals convicted of misdemeanor domestic violence, and those person(s) who are under a Restraining Order or Protection Order for domestic abuse and the law is applicable in all fifty states and US territories. The act also makes it unlawful to knowingly sell or give a firearm or ammunition to such person(s).

 

I understand that I must follow all safety rules during training as prescribed by the instructors, staff and management of Close Quarters Battle Institute, Inc.; and that I understand the training depends upon the careful control and use of deadly weapons by each person attending; and that I understand my instruction may be terminated at any time during the course if my conduct is not deemed satisfactory at the sole discretion of the instructors, staff and the designated Range Safety Officer (RSO). I understand that I will follow all safety rules as prescribed by Close Quarters Battle Institute, Inc.;  and that I  release Close Quarters Battle Institute, Inc. from responsibility for any injury that I may sustain during the course of the training program. I also understand varrious techinques are used to induce stress including verbalization, physical exertion and qualification. courses.

 

CANCELLATION POLICY:     

 

I understand that my tuition is fully refundable only if Close Quarters Battle Institute, Inc. cancels my class; and I fully understand that if I cancel, the tuition is NON-REFUNDABLE; and I fully understand that tuition will be applied to hold a seat in another available class.

 

SIGNATURE:

 

Applicant:  Date:   

 

 

AGENCY/UNIT PURCHASE:   Yes    No     If yes, provide information below.

 

Provide information below if registering on behalf of personnel from your law enforcement agency or military unit.

Registering Official:   Title:    Agency/Unit:

Purchase Order Number:  Telephone Number:   

 

Authorizing Official:   

 

PREPARE TO PRINT:

 

Set margins to the following on your printer page set-up:

 

Top       - 0.5

Bottom  - 0.5

Left       - 0.5

Right     - 0.5

 

PRINT

 

(1)  Print Form 

(2)  Sign and Date 

(3)  Keep Copy for your records

(4)  FAX, Mail or Email a signed application along with required documents 

(5)  Complete STEP 2

 

STEP 2     (Click button)

 

(1)  Select course

(2)  Major credit cards and PayPal accepted

(3)  Pay tuition

(4)  Receive confirmation within 24 hours