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.

***PLEASE MAKE DOUBLE CHECK TO MAKE SURE YOU ENTER ALL INFORMATION CORRECTLY***

Date of Class you want to attend *
MM
/
DD
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YYYY
Last Name *
Your answer
First Name *
Your answer
Middle Initial *
Your answer
Gender (enter M or F) *
Your answer
Age (at the time of class) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
State (NE) *
Your answer
Zip Code *
Your answer
Phone Number (format like) 402-555-1212 *
Your answer
NE Drivers License Number (format like) H01234567 *
Your answer
Email Address *
Your answer
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