NSSA Instructor Course Application

NSSA Level 1
Instructor Course Application


NSSA Number:
First Name:
Middle Initial:
Last Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Cell Phone:
EMail Address:
DOB:
Current NSSA Class:
Highest NSSA Class:
NSSA Registered Lifetime Targets:
Course location and date you are requesting:
Cost: $250.00 Course material will be provided by the instructor Shooters are responsible for: Shotgun, ammunition, eye & ear protection, shell pouch or vest. Personal target fees. Equal share of the certifying instructor's travel. Important: All applicants MUST complete the Background Check Agreement with their application. Enter only the participant's information; use the payer’s only if it’s the same person. Falsification of the above information will result in disqualification and the return of all prizes and monies for all events. Falsification of classification information could also lead to suspension from the NSSA. I Agree with the above Disclaimer*