Nebraska Concealed Carry Class Registration
Please complete all of the required information below. This information is all necessary to complete the NE State Patrol paperwork and certificate of completion for the class.

*ENTER YOUR NAME EXACTLY AS IT APPEARS ON YOUR DRIVERS LICENSE* (Don't use nicknames)

**MAKE SURE YOU ENTER YOUR DRIVERS LICENSE NUMBER CORRECTLY** (what you enter is what will appear on your training certificate)

***PLEASE MAKE DOUBLE CHECK TO MAKE SURE YOU ENTER ALL INFORMATION CORRECTLY***
Date of Class you want to attend *
MM
/
DD
/
YYYY
Last Name *
First Name *
Middle Initial *
Gender (enter M or F) *
Age (at the time of class) *
Date of Birth *
MM
/
DD
/
YYYY
Address *
City *
State (NE) *
Zip Code *
Phone Number (format like) 402-555-1212 *
NE Drivers License Number (format like) H01234567 *
Email Address *
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