NORTHERN ILLINOIS' #1

Professional Illinois Concealed Carry Training program designed  and taught 
by nationally certified tactical firearm training experts

ILLINOIS STATE POLICE APPROVED



AMERICAN MEDICAL RESOURCE INSTITUTE ILLINOIS CONCEALED CARRY COURSE APPLICATION

PRINT OR TYPE


COURSE DATES ENROLLING FOR:_________________________________ 



FIRST NAME______________________________ LAST NAME_______________________________MIDDLE INITIAL_____________



MAILING ADDRESS___________________________________________________________________________________________



CITY__________________________ STATE_____ ZIP___________________ DAY PHONE (______)__________________________



ILLINOIS FOID NUMBER *_____________________________________________EXPIRATION DATE__________________________



EMAIL ADDRESS: ___________________________________________________@_______________________________________



YOUR AGE _____________   SEX ______________  DO YOU HAVE ANY PHYSICAL LIMITATIONS?     YES____      NO____



TUITION: $2 95 (full 16-hour course)   $1 95 (8-hour course)     CHECKS PAYABLE TO:  AMERICAN MEDICAL RESOURCE INSTITUTE


If you would like to pay by credit card, call us at: 1-800-272-9064  (Monday - Friday 9am-5pm)


* FOID is not required if you are not an Illinois resident. If you are an Illinois resident waiting for the State to send your FOID card, you may take the classroom sessions, 

however, you will need to show your current FOID card to participate in the live-fire range practice and qualification.


YOU CAN PRINT THIS APPLICATION AND MAIL TO:        FOR CREDIT CARDS:  CIRCLE TYPE        (MC     VISA     AMEX     DISCOVER)


AMERICAN MEDICAL RESOURCE INSTITUTE                    

2-B Public Safety                                                                    NAME ON CARD_____________________________________________

715 Ela Road

Lake Zurich, IL 60047-6300                                                   CARD NUMBER_____________________________________________

                     

FAX: 1-888-833-2674                                                            EXPIRATION ______/_________  SECURITY CODE ________________


scan/email:  administration@amrieducation.org




YOUR SIGNATURE___________________________________________          AMOUNT CHARGED $________________________