Registration form - Government of New Brunswick

Registration form - Government of New Brunswick

CANADIAN RESTRICTED FIREARMS SAFETY COURSE
STUDENT ENROLLMENT FORM
STUDENT INFORMATION
Language:
Last name:
English
French
Middle name:
First name:
Gender:
Male
Female
Date of Birth : (YYYY/ MM/ DD)
Mailing address (Street /land location / rural route / P.O. box number)
Apt./Unit :
City:
Province:
Country:
Daytime phone number:
Evening phone number:
Email :
Postal :
COURSE LOCATION
Bathurst
Campbellton
Edmundston
Fredericton
Grand Falls
Miramichi
Moncton
Saint John
Shippagan
St. Stephen
Woodstock
Other (specify):
Course date requested:
Course fee (classroom instruction and testing): $65
Manual:
1) Available to purchase at your local Department of Energy and Resource Development and Service New Brunswick offices or
2) Download online at http://publications.gc.ca/site/eng/9.801815/publication.html
Fee Enclosed (amount)
Indicate the method of payment. Do not send cash. Make payable to Minister of Finance
Certified Cheque
Money Order
MasterCard
Visa
If paying by credit card, complete the credit card information
Credit card number
Expiry date (mm-yy)
Name appearing on credit card
I authorize the Provincial Firearms Office to charge my credit card for the amount shown above.
Cardholder’s Signature
Date (y-m-d)
*** Seating is limited – Registration will be accepted on a first come first serve basis ***
Return with payment to the contact information below:
Chief Firearms Office / Bureau du contrôleur des armes à feu
www.gnb.ca/firearms / www.gnb.ca/armesafeu
www.rcmp-grc.gc.ca/cfp-pcaf
Justice and Public Safety / Justice et Sécurité publique
P.O. Box / C. P. 6000 Fredericton New Brunswick / Nouveau-Brunswick E3B 5H1 Canada
Toll Free Telephone / Téléphone sans frais : 1-800-731-4000 ext. / poste 6000 Fax / Téléc. : (506) 457-3521 Email / Courriel : [email protected]