Loading...
HomeMy WebLinkAbout183969 03/29/2010 CITY OF CARMEL, INDIANA VENDOR: 362959 Page 1 of 1 E ONE CIVIC SQUARE VIKING TACTICS, INC CARMEL, INDIANA 46032 3125 HEATHERBROOKE DRIVE CHECK AMOUNT: $11,060.00 FAYETTEVILLE NC 28306 CHECK NUMBER: 183969 CHECK DATE: 3/29/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 21344 21666 600.00 TRAINING 210 4357000 21359 21989 300.00 TRAINING 210 4357000 21356 21990 375.00 TRAINING 210 4357000 21842 22794 9,560.00 TRAINING 210 4357000 21837 22795 150.00 TRAINING 210 4357000 21337 22798 75.00 TRAINING Viking Tactics, Inc. I1IVOICe 3725 Heatherbrooke Drive Fayetteville, NC 28306 a`y� Date v X4 H� Invoice Phone: (910) 987 -5983 Fax: (910) 425 -0700 3/13/2010 22794 www.vikingtactics.com TIN: 55- 0876923 7 mel rtment City of Carmel Police Department sa Anderson ATTN: Teresa Anderson 3 Civic Square 3 Civic Square Carmel, IN 46032 Carmel, IN 46032 a �PONumber Terms& :Sales Rep °`ShlppingADate w'� Uia�FOB gym` m a- sisx:�z -:...0 e, a f is 21842 Net 30 MLamb 3/13/2010 Quantity Item Code Description Price Each Amount 14 Viking Tactics CQ13 Training 12 -14 May 2010, MUTC, IN- one 682.85714 9,560.00 instructor, three eight hour days Discount two slots, Carmel will have 16 participants Weapons, Ammo and Targetry will be provided by the customer Collins; Clark; Dawson; Dunlap; Fisher; Gilbert; Jellison; Locke; Long; Loveall; Miller; Myers; Paris; Pitman; Scott; VanNatter Subt tal $9,560.00 M KI NG NC Sales Tax (8.0 $0.00 Invoi a Total $9,560.00 Pay ents /Credits $0.00 We look forward to doing business with you in the future! Please call if you have any questions. $alance1Due S9,'56Q., ti Viking Tactics, Inc. If'11/ ®ICC 3725 Neatherbrooke Drive Fayetteville, NC 28306. 'F Phone: (910) 987 -5983 ti ,C Invoice RP Fax: (910) 425 -0700 2/18/2010 21989 www.vikingtactics.com TIN: 55- 0876923 City of Carmel City of Carmel Police Department Police Department ATTN: Teresa Anderson ATTN: Teresa Anderson 3 Civic Square 3 Civic Square Carmel, IN 46032 Carmel, IN 46032 F 8 r k R P O Number .•�Ter,ms'I �SalesuRep Shipping hate Via is ,Gk 21359 Net 30 MLamb 2/18/2010 Quantity Item Code Description Price Each Amount 4 Instruction Kyle Leadership Seminar May 11, 2010 75.00 300.00 Shane VanNatter; Dan Jent; Greg Loveall;Scott Long Subt tal $300.00 iip�, G m NC Sales Tax (8.0 $0.00 NA H� {nvoi a Total $300.00 1 E -Y:- ents /Credits $0.00 We look forward to doing business with you in the future! Please call if you have any questions" X EBalance Due $300 110, v �`p Viking Tactics, Inc. Invoice 3725 Heatherbrooke Drive kc Fayetteville, NC 28306 Phone: (910) 987.5983 'Invoice Fax: (910) 425 -0700 2/18/2010 21190 www.vikingtactics. corn TIN: 55- 0876923 City of Carmel 7AN: of Carmel Police Department ce Department ATTN: Teresa Anderson Teresa Anderson 3 Civic Square 3 Civic Square Carmel, IN 46032 Carmel, IN 46032 P O Numbers F g ins Sales Rep �Shippmg Date �s *Vla�� �.a.aa�a 21356 Net 30 MI-amb 2/18/2010 Quantity Item Code Description Price Each Amount Instruction Kyle Leadership Seminar; May 1 1, 2010; Carmel, IN 75.00 375.00 Meyer, Locke, Schoeff. Dunlap, Paris Subtotal $375.00 VIKING NC Sales Tax (8.0 $0.00 ncs Invoi a Total $375.00 Pay ents /Credits $0.00 We look forward to doing business with you in the future! Please call if you have any questions t Balance Due E= r X3700 a Viking Tactics, Inc. Invoice 3725 Heatherbrooke Drive Fayetteville, NC 28306 Date; Invoices# Phone: (910) 987-5983 X Z1 Fax: (910) 425 -0700 2/9/2010 21666 www.vikingtactics.com TIN: 55. 0876923 City of Carmel City of Carmel Police Department Police Department ATTN: Teresa Anderson ATTN: Teresa Anderson 3 Civic Square 3 Civic Square Carmel, IN 46032 Carmel, IN 46032 x P O Num er Terms; Sales Rep' Sh►pping Gate 1 a [la E F 0 Y 1 ..0 a t� r�,... K€ 21344 Net 30 MLarnb 2/9/2010 Quantity Item Code Description Price Each Amount Instruction Kyle Mirch 25-27,2010, NightFighter, Linden, NC 600.00 600.00 RE: Sgt, Brady Myers Subt tal $600.00 NC Sales Tax (8.0 $0.00 Invoi a Total $600.00 Pay ents /Credits We took forward to doing business with you in the future! Please call if you have any questions. Balance Due �k �"`$GUO f)0� ti Viking Tactics, Inc. Invoice 3725 Heatherbrooke Drive Fayetteville, NC 28306 lnvoiM Phone: (910) 987 -5983 Fax: (910) 425 -0700 3/13/2010 22798 www.vikingtactics.com TIN: 55- 0876923 7ATTN a armel Cit y of Carmel epartment Police Department Teresa Anderson ATTN: Teresa Anderson 3 Civic Square 3 Civic Square Carmel, IN 46032 Carmel, IN 46032 x P'0 "eNumber Terms Sales Reps Sh�p�ping Datee 1/ia 21337 Net 30 MI-amb 3/13/2010 Quantity item Code Description Price Each Amount Instruction Kyle Leadership Seminar; May 11 2010; Carmel, IN 75.00 75.00 (Charlie Harting) Subt )tal 575.00 VI c n s NC Sales lax (8.0 $0.00 Invoi e Total $75.00 Pay ents /Credits 50.00 We look forward to doing business with you in the future! Please call if you have any questions1��� r ;Balance Due` c Viking Tactics, Inc. In voice 3725 Heatherbrooke Drive Fayetteville, NC 28306 Date F, 7 1nvo'ice w k r Phone: (910) 987-5983 Fax: (910) 425 -0700 3/13/2010 22795 www.vikingtactics.com TIN: 55- 0876923 City of Carmel City of Carmel Police Department Police Department ATTN: Teresa Anderson ATTN: Teresa Anderson 3 Civic Square 3 Civic Square Carmel, IN 46032 Carmel, IN 46032 P Nurnber�EWTerms ....:SalesRep �h :ppingDate x� UlaF p 6- .,u r... 21837 Net 30 MLamb 3/13/2010 Quantity Item Code Description Price Each Amount 2 Instruction Kyle Leadership in the Shadows; May 11, 2010; I1V 75.00 150.00 (Scott /Pitman) Subt tal 5150.00 t+EC Sales Tax (8.0 $0.00 K I1 G c Invoi re Total $150.00 Pay entslCredits $0.00 We look forward to doing business with you in the future! Please call if you have any questions 4 'n TNR" 4,' k LBalance Due 5150 00 j,G. sv A a: raw �wr-v.ta v m Cit o 0 ''INDIANA RETAIL TAX EXEMPT PAGE 1 of 1 f Carmel CERTIFICATE NO.Op3120155 Opt 0 PURCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 r 213 3 i%f CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, NP CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION February 18, 2010 training SHIP VENDOR Tactics City of Cat>eI Police Department 3725 rteatherbrooke Drived TO 3 Civic Square Fayetteville, NC 28306 -9718 Camel, IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Leadership in Shadours school for Officer Shane 75.00 300.00 VanNatter, Officer Dan Sent, Officer Greg Loveall, and Officer Soott Long, on May 11, 2010 in Westfield, I P 7 1- �s r� r -tea ti` c�., City of Carmel Poi r Send Invoice To: ATTN: Teresa Anders 3 Civic Square Cartel, IN446032 PLEASE INVOICE IN DUPLICATE 4 DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 210 570 cont ed m PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO�PAYYY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY PURCHASE ORDER NUMBER MUST APPEAR ON ALL r SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Poli AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2 `a. 1 CLERK- TREASURER DOCUMENT CONTROL NO. A. COPY -SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT NO. ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO #or INVOICE NO. ACCT #frITt_E AMOUNT DEPT. I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 20 Signature Title I I Cost distribution ledger classification if claim paid motor vehicle highway fund Viking Tactics, Inc. 3725 Heathetrooke Drive Fayetteville, NC 28306 -9718 C: PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www,VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES 1 2 1 First Name MI Last Name Email Address: 1 ate of Birt 1 l Age: Home Address: G C' City:' State Zip Occupation: Z6Z Military or LE Affiliation: l� Rank: Work Address: Ct� City, Stat Zip Home Phone Work Phone:iZ �'f� Former Student: Yes to If yes, provide prior dates: Z�41 Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: Pistol License Number: Secondary Weapon Type and Calibe r, Z ff2?—AZ State of Issue: Expiration Date: COURSE DATE:/ "OURSE NNAA 1� i re- Requisites MT es No Emergency Name: Emergency Phone: j LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. 3 Certificate of Go nduct (from your local Pori artm "v Active Dut olice I 'Police Dept/Unit ".4'r Badge I Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: Pistol License No. (any state) or CCW Permit No, Exp. Date_ State of Issue A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION 3 A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. I Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. I Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments) Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www,VIKINGTACTICS. COM Registration and Application for Training Viking Tactics, Inc. /Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS QUILL SE ACCEPTED TOPARTIC IH VTAC COURSES First Name 5 bq AP MI C Last Name 1 4 4 5 Email Address: SCO 1 (in 5 aCcerme.I. r pV Date of Birth: Q 7 I Age: Home Address; 131 Q/A w-M4y LA. City: a row j State W Zip Occupation: PIP lire Military or LE Affiliation: arm-cl �e�'�P �f Rank: Work Address: 3 Cj ✓iG �9. City: Crnte State T/V Zip q 03 Home Phone (31 S_� yS r Work Phone: (3� 5 5 7 Former Student: ge No If yes, provide prior dates: Ksh D S miter QQ02 Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caber. &AA A �s Pistol License Number: Secondary Weapon Type and Caliber: State of Issue: Expiration Date: A9 S- IN- tp COURSE DATE: 1t0 COURSE NAME: Pre -R Met Yes Emergency Name: 01 r Emergency Phone: 11 S 7?"1 LEfMilitary Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant Submission of this application indicates your clear understanding of this requirement Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. 8 Certificate of Good Conduct (from your local olive DeP" nn Q 1 Active Duty Police Id; Police DepUUnit local al 1'9 �nD� s 1/A Badge o f 8 Active Duty Military; (No lD copy required) Unit Branch of Service If Civilian Provide Either. Y Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue t A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION V A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. V Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number. Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. a 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name MI Last Name eAl Email Address: roses n AV Date of Birth: I I .FE' I G,' Age: Home Address: y Z &JdAKt &yA✓ XA.)„ City: State Zip y6433 Occupation: ldli,r DAr'yc�. Military or LE Affiliation: A!� Rank: A= Work Address: 3 C u'W Pe.O City: �i9�mf16 —State Zip J�6 7 Z Home Phone (3�7) y Phone, 57f 2,So y Former Student: &I No If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: /Z y!J C j Pistol License Number: Secondary Weapon Type and Caliber: _may Z Z State of Issue: Expiration Date. COURSE DATE: �/Z COURSE NAME: 1/1 Pre- Requisites Met: Yes No Emergency Name: Emergency Phone: LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. Certificate of Good Conduct (from your loc olive Depart en i.z Active Duty Police Id; Police Dept/Unit l► i Badge 7-17 Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue Z; A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 36 days, and we cannot fill your slot, we retain 50% of your tuition. Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NIC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Appiication for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name L, ska L r MI I Last Name Email Address: J" ,,.4 f oD C-cLlw l g4a 1 Date of Birth: L f 1 it 1 73 Age: 36 Home Address: 73 5. 16 r �i Ci, e- City: 1= a t s State Zip �e Occupation: P r re- r Military or LE Affiliation: rv, P,�rc e Rank: �o�rr�aot Work Address: C ut c e City: ,3t State tic.) Zip Horne Phone J o Work Phone: i V s7l scu d Former Student: Yes 16 if yes, provide prior dates: Weapon Information. If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: R41 c.k 2 i %Ae r s XZ3 Pistol License Number. Secondary Weapon Type and Caliber: jo L +40 State of Issue: Expiration Date: COURSE DATE: s COURSE NAME: v G e Pre Requisites Met: Yes 1 No Emergency Name: ..T s J7 Emergency Phone: l 7 LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options, 1 Certificate of Good Conduct (from your local olice Dep mept� 't' Active Du e Police Id; Police De p 4_ t/Unit e, ✓h I -<1 Bad g e G Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: tr Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue V A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION 1' A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. T Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. 'i Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number. Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. I Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name (f%LAv_Lf_s MI 2 Last Name Fssap_o_ Email Address: cq;sher Cctrvy%4 i .sr-t. l�:,o\t Date of Birth: 6, Age: Home Address; Noz SA.1DN Pe ster LA rJ( City: State x, Zip Occupation: Pocsc.e o Fr_cArz Military or LE Affiliation: &"6z- t` Rank: P,&,a, Work Address: 3 Cxuti, Sa,6gE City: Ca e- L_ State Zip q o3 Home Phone .311 4io 739 Work Phone: 317 s Former Student: Yes I,P If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: I3cocic Z7 ZO e A Pistol License Number: Secondary Weapon Type and Caliber. AIL. J T Qor- 7 State of Issue: Expiration Date: COURSE DATE: s l l z 5/i COURSE NAME: L Q 3 Pre Requisites Met: Yes I No Emergency Name: k.Aa" asot rL Emergency Phone: 317 -At,q- 2 yg LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. 't Certificate of Good Conduct (from your local Police Department) 7 Active Duty Police Id; Police DeptlUnit CA2M &L r-c-E t r Badge 2278 V Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue V A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION I A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. 3 Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. 7 Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Cade: Viking Tactics, Inc. u 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Reaistration and App cation for Training Viking Tactics, Inc. I Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name W; MI T Last Name Email Address: _t5trk vkel DateofBirth: I 1 I� Age: 33 home Address: I II i3��Ke R a City: C"' t State �N Zip (oc3 'L Occupation: Q 'Pj Military or LE Affiliation: e :fir Rank: Work Address: 3 C', Ss?. City: State Zip 4tao s a Home Phone 3L L 1 1 1a Sc!09 Work Phone: 3o s as Former Student: Yes6D If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: h tZl s 2.7- Pistol License Number: Secondary Weapon Type and Caliber: ht o0r, 21- 4-0 State of Issue: Expiration Dale: COURSE DATE: S'113 .S'1` COURSE NAME: CQ S Pre- Requisites Met: Yes I No Emergency Name: e. Emergency Phone: VC Cv4'71 LEIMilitary Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. a Certificate of Good Conduct (from your local Police Department) V Active Duty Police Id; Police Dept/Unit L-A. b Badge 23S'i t Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: V Pistol License No. (any state) or CCW Permit No. Exp. Date— State of Issue 7 A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. t Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. 'n Deposit is waived for PO mittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. (Note an additional 5% will be added to course fee for processing CC payments) Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 F PHONE: (910) 987 -5983 4C FAX: (910) 425 -0700 uvww.VIKINGTACTICS.COM Registration and Aj�lication for Training Viking Tactics, Inc. 1 Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name MI J)_ Last Name _U'L11 i Email Address: 5 on:) C-4 A,-e -1 a y Date of Birth: io 1 _2L Age: ,3,9 Home Address: `155 A n City: N 65 Y, 1I e State zip Zip yL�[�z Occupation: Ru i e Military or LE Affiliation: &61� j e t Pte -c� Rank: Work Address: 3 City: State Zip `ll�o Home Phone 27 LS Work Phone: (7_ Former Student: No If yes, provide prior dates: T 1 f, -S Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: Pistol License Number: Secondary Weapon Type and Caliber: State of Issue: Expiration Date: COURSE DATE: a //2 11 COURSE NAME: V T Gig {2 Pre- Requisites Met: Yes 1_INO Emergency Name: Emergency Phone: 7 5 4 of S LEIMllitary Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse tr oning fqr any reason whatsoever to ny applicant. Submission of this application indicates your clear understanding of this requirement. e c, /70a 7 00 s /24 -wc-. C— Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. 1 Certificate of Good Conduct (from your local Police Department) T Active Duty Police Id; Police Dept /Unit Badge t Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: T Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue t A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. T Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. it Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc, (Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: MWJJ Viking Tactics, Inc. M 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH [TAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name MI --L— Last Name 1c Email Address: LM-m EL— -1 Q C'n-,V Date of Birth: of Age: Home Address: 3 c-t 0, C- City: C. o m t State Zip Occupation: Rk�c-E oHztc- Qf Military or LE Affiliation: Rank: 6 Work Address: 3 C-�k &L L S2Lc -ArZC City: �.r'+R (=L State -+y Zip C 6 3 Home Phone 6AJ 7� L 5 q7 Work Phone: 31 5 25 2- Former Student: Yes Co If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: JM `S Pistol License Number: Secondary Weapon Type and Caliber: g o C hL State of Issue: Expiration Date: COURSE DATE: S q i0 COURSE NAME: ,0 r s Pre Requisites Met: YL?f No Emergency Name: Emergency Phone: i f'1- I)( ?.3 IS I LE /Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. Certificate of Good Conduct (from your local Police Department) x' Active Duty Police Id; Police Dept/Unit CA P-m mil_ Ya U c F Badge 1J t Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: t Pistol License No. (any state) or CCW Permit No. Exp, Date— State of Issue t A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. t Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. I Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9798 PHONE: (990) 987 -5983 FAX: (99 0) 425 -0700 www.VIKINGTACTICS.COM Registration and Armlication for Training Viking Tactics, Inc. 1 Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name' c'_a'r MI b• Last Name Lo Q Email Address: tr yKe l i J r)Q Date of Birth: 1 Z. /-3-6 Age: Home Address: 577IZ.VsJy7EG2Sr City: -f02S State Zip Occupation: P b 4 0r1 GE2 Military or LE Affiliation: tr PQ1;C1- Rank:P i A 1,�1 w0r Work Address: 3 C U i C, A A City: CA C—L State_ Zip 4U 3Z Home Phone 7 4- 11;(2 Work Phone: 0 '11 26 Former Student: Ye No yes, provide prior dates: Weapon Information: r If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: A lbc k- 4V LQ.(1 D en- Pistol License Number: Secondary Weapon Type and Calib Q R 7 Z23 �(1 State of Issue: Expiration Date: COURSE DATE: z S U COURSE NAME: QJ5 Pre- Requisites Met: Yes I No Emergency Nam &A 1 [LA1 f Emergency Phone: 3 17— 7 74 lig(g LE /Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected, There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE /Military: Select one of the following options. t Certificate of Good Conduct (from your local Police Department) `6' Active Duty Police Id; Police Dept/Unit rl�fl'�L' AZL( r Badge Jobi? v Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: T' Pistol License No. (any state) or CCW Permit No, Exp. Date_ State of Issue I A current copy of a Criminal Record History Check from your slate of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. T Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 900% of your tuition, if you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. tr Deposit is waived for PO remitt ances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. '(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: L Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 vaww.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. l Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name �re- gorq MI Last Name 1 ,OU6AZ Z� Email Address: Greg E 9nWi f'. C av' Date of Birth: Age: 2 S Home Address: 5 pe City: /j /��s State Zip YP 3 0' Occupation: ralc s pf"'Ice-g Military or LE Affiliation: Rank: Work Address: 3 C1y1C; SQ1AR2t City: C f'� G State rN zip /O; Home Phone (p7) VI 3 q 7 Z 9 Work Phone: Former Student: Yes /P If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber if LaCk Z Z 7 y CD r Pistol License Number: Secondary Weapon Type and Caliber: 6 6 DCk .2 7 V P CAI State of Issue: Expiration Date: COURSE DATE: 5 -11 1 10- 5114 COURSE NAME: C PO Pre Requisites Met: 1 No Emergency Name: Emergency Phone: r✓�� LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement, Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. 1 Certificate of Good Conduct (from your local Police Department) G Active Duty Police Id; Police Dept/Unit L f v'C� Badge 1 Active Duty Military; (No ID copy required) Unit Branch of Service It Civilian Provide Either: V Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue 1 A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION 3 A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. I Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. I Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. *(Note an additional 5 %will be added to course fee for processing CC payments) Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. N 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VlKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name A MI 0% Last Name M i I IE-,.r Email Address: ate A 1 I--E. E IL C,_ 6j40 L.. TAJ.. L Date of Birth: 1 7 f Age: Home Address: I3 a(,, t Is;•►�ri��(� j ss City: �i��n� .I State Z� Zip 4 16[ 3 Occupation: Military or LE Affiliation: Pdlf� Rank; _Sc�A Work Address: 3 (2 u I�L 'S� City: C'� c State T-r-! Zip U 1x4 Q Home Phone 317 8 16 CfJ 39 Work Phone: I ;L) r I c? S_'7 Former Student: Yes to If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: 6 14 LC 4 Pistol License Number: Secondary Weapon Type and Calibe �r•c.3 p State of Issue: Expiration Date: COURSE DATE: M a I I L4 COURSE NAIVE: Pre- Requisites Met Yes No Emergency Name: L s e FY) 6T Emergency Phone: LEIMilitary Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant Submission of this application indicates your dear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. V Certificate of Good Conduct (from your local Police Dep" t Active Duty Police Id; Police DepUUnit f n `E` 1 L� ��Pt Badge 5 S V Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: t Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue t A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION V A deposit is required to reserve your seat Refer to the Course Announcement for the amount. t Course Cancellation Policy: We require the full tuition up front to reserve your slot If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. V Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number. Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name MI ll`�-_ Last Name iM r_S Email Address: C�C"-'j t n raj Date of Birth: I I Age: Home Address: 1 Ptn .l l' City: 1') .Y_ I c State Zip Occupation: Military or LE Affiliation: <f, Rank: Work Address: �1, ;,t C-/ R- city: State Zip Home Phone test 'i" Work Phone: a Former Student: (Vs 1 No If yes, provide prior dates: hrp 7 cc C1 I ,,s u.r I&CA ue Weapon Information: If Qvilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: Pistol License Number Secondary Weapon Type and Caliber. Cq fc r e lf l' i f:. State of issue: Expirstiat Date: COURSE DATE: SS -1 S�iti COURSE NAME: 1� ci Q�,'�5 Pre Requisites Met:. No Emergency Name: ,saw _r s Emergency Phone: 3 f 7 4 50 Credentialing Policy: VTAC has a strict credentialing policy. A photocopy of ONE of the following must be emailed (lamb(c)vikinatactics.coml taxed (910 -987- 5983), or mailed LISPS: 7 Certificate of Good Conduct (from your local Police Department) Active Duty Police Id, Police Dept/Unit 16 Badge 1 1, Active Duty Military Id; Unit Branch of Se rvice If Civilian Provide Either: V Pistol License No. (any state) or CCW Permit No, Exp. Date_ State of Issue V A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. LE/Police Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the above will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understamling of this requirement. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAO PAGE FOR UPDATED INFORMATION A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. Course Cancellation Policy: We require the full tuition upfront to reserve your slot. If you cancel outside of 30 days, we will refund 100 of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. v Deposit is waived for PO remittances and Mil Orders. If submitting online, fax or email, deposit or payment in full must be made within 5 days of submission. Payment method: Check Purchase Order Credit Card Amount If paying by credit card: MAKE CHECKS PAYABLE T0: Viking Tactics, Inc. Payment Information: Send Payments to Name on Credit Card: Viking Tactics, Inc. Credit Card Number: 3725 Heatherbrooke Drive Expiration Date of Card: Code: Fayetteville, NC 28306 Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 IC FAX: (910) 425 -0700 vvww.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. I Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name 1/a MI j Last Name Email Address: 0100, 5 C ('a -.o 5o1i Date of Birth: 's 3r- 7 2 Age: 3 Home Address: i Iq 7 7 s r L1) F -.P—AJb p '09- City: r- IS 4-6-P-s State r--) Zip 4 Occupation: CL4 Military or LE Affiliation: L C 6 c e Rank: �d Work Address: 3 C City: State Zip Home Phone f7 i Work Phone: (3_L. 57' a "0 O Former Student: Yes 1 If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: k Lk A dc, ARI S :Dlzl- 3 Pistol License Number: Secondary Weapon Type and Caliber. 6 )L r_k 2 k ®yQ State of Issue: Expiration Date: COURSE DATE: S NAME: C Pre- Requisites Met: Yes 1 No Emergency Name: Hest it A c e s Emergency Phone: (7 7f, -10 2 3 LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. V Certificate of Good Conduct (from your local Police Department) T Active Duty Police Id; Police Dept/Unit Badge V Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either t Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue t A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION 't A deposit is required to reserve your seat, Refer to the Course Announcement for the amount. I' Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition, If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. F Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Ordei Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. (Note an additional 5% will be added to course fee for processing CC payments) Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. l Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATES IN VTAC COURSES First Name /44 ep MI _k Last Name �i Email Address: I P1 hJ 0 nome Id 504 Date of Birth: —!V Z3 1 76 Age: 31 Home Address: City: State Zip Occupation: k D P G Military or LE Affiliation: Rank: Work Address: C Ur'C Sf' aw City: 64141ZJ State 1 Zip 65 Z Home Phone Work Phone: (1) Former Student: Yes( If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of issuance and Expiration Date: Primary Weapon Type and Caliber: Pistol License Number: Secondary Weapon Type and Caliber: State of Issue: Expiration Date: COURSE DATE: 4 COURSE NAME: Pre Requisites Met: Yes 1 Emergency Name: Emergency Phone: LEIMilitary Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. Certificate of Good Conduct (from your local Police Depart�jjnt) n J C Active Duty Police Id; Police Dept/Unit CVA0 I J U✓�� Badge 9 &7— Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: a Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. u Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and A pplicati on for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ]TAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name C ur l' MI lb Last Name Sc Email Address: CScotkC C tN. Date of Birth: 1 1 Age: q,? Home Address: t `i 0'� 0 A c D, v P City: Ekpv-s State -TN Zip ±G__07 Occupation: PL' (tLP_ 0 M4Q�- Military or LE Affiliation: Co'rme'( N k c.a Rank: Work Address: 3 6v c- S LLOLM City: G-1viehDA State 1 Zip o Home Phone l-1 74 Z Work Phone: L' 5 71 250 Former Student: Yes 1(G If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber. `-Z .40 cxc k Pistol License Number: Secondary Weapon Type and Caliber: 2. Ck 5 �a +4 Y K State of Issue: Expiration Date: COURSE DATE: <1(L- COURSE NAME: C Q, La Pre Requisites Met: 1 No Emergency Name: L i L �i_ Emergency Phone: '1 tZ 1 2.ritf C LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected, There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy.. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. Z Certificate of Good Conduct (from your local Police Department) t Active Duty Police Id; Police Dept/Unit k t P- Badge 5 (1� V Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: t Pistol License No. (any state) or CCW Permit No. Exp, Date_ State of Issue A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. 't Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. 1 Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments) Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name 611AIVE MI Last Name VA /1 ^l A T 7_Z Email Address: S VA ANA i rF,C c A Km cc /N. coV Date of Birth: 7 7a Age: Home Address: 5 ?6o 1409 /QEAV CT City: CAtA4 L State Zip L4 63 Occupation: Poi I c E Military or LE Affiliation: USM C Rank: 5 "7 T_ Work Address: 3 Cfofc, -Sa• City: CAKME4- State /AI Zip 5 Home Phone SGy /137 Work Phone: 317 2s66 Former Student: Yes/ la If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: G i c k 22— 4 0 Pistol License Number: Secondary Weapon Type and Caliber: Ak 7 S ZZ3 State of Issue: Expiration Date: COURSE DATE: 5 COURSE NAME: C Q.Q Pre Requisites Met: Yes No Emergency Name: NC4 1.1 Emergency Phone: 317 S-Y 1676 LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE /Military: Select one of the following options. Certificate of Good Conduct (from your local Police Department) 3 Active Duty Police Id; Police Dept/Unit Po Badge 2-7Z3 t Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. t7 Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Ar)plication for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name ffal t' MI Last Name do('Lt 1n Email Address r s cl in, Gov Date of Birth: QG 1 7-z &S Age: Home Address: 1195 6. /(P r S City: /�o0esu State TAI Zip Occupation: oJ, (,e. Military or LE Affiliation: 1 Rank: k�� &C Work Address: 3 City: Cap--m State Zip 1 4o3 1 Cetl Idme Phone 317 q2_0; Work Phone: 31 7 5'7 257) k 11 Former Student: Yes to If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: GleCt y� Pistol License Number: Secondary Weapon Type and Caliber: State of Issue: Expiration Date: COURSE DATE: 5 11 1 0 1 D COURSE NAME: 4-kc SL„4 uWS 4 Conn 4� vnr:'dte it_ P Pre Requisites Met: Yes 1 No Emergency Name: MA Luc ILA e CKt.J Emergency Phone: 3 17 —S71 Z S3 q LE /Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LEIMilitary: Select one of the following options. s Certificate of Good Conduct (from your loco Police Departmen o Active Duty Police Id; Police Dept/Unit Ct Badge 5` V Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: V Pistol License No. (any state) or CCW Permit No. Exp. Date— State of Issue V A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAO PAGE FOR UPDATED INFORMATION i, A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. u Deposit is waived for PO remittances and I Orders. Payment method: Check Purchase Orde Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 4C FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Application for Training. Viking Tactics, Inc. I Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name (jfX MI Last Name ��/�YIA-r�l Email Address: J. -N Date of Birth: --V1 03 Age: Home Address: City: State Zip Occupation: Military or LE Affiliation: Rank: Work Address: 3 by e City: L' *A State 73W Zip Ab p Home Phone Work Phone: Former Student: Yes 1L".i' If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: Pistol License Number: Secondary Weapon Type and Caliber: 66 State of Issue: Expiration Date: COURSE DATE: �h COURSE NAME: LeADef- 0 6 Pre Requisites Met: Yes No Emergency Name: Emergency Phone: LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application, LE/Military: Select one of the following options. Certificate of Good Conduct (from your local Police DepartVW //J �a� Active Duty Police Id; Police Dept/Unit IQl Ch Bad e Pt0,7 Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: Pistol License No. (any state) or CCW Permit No. Up. Date_ State of Issue A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card_ Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments) Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card. 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 4C FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. 1 Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name CV* MI ILN Last Name S-c'6` Email Address: C Scot's Z C-C'V" "C1 t In ov Date of Birth; v 1 13 1 Ga U Age: Y1 Home Address: f `1 3ci Nu Ln b ri yA City: j k&w� State Zip L I(voti Occup ation: Gficn Mil or LE Affiliation: �r ✓'YMCi art p P to ry 1 v Rank: M Fo Work Address: 3 Cry'c SQ ua V'e City: CLrhA al State X! Zip '(60 Home Phone -I?-) 77`( ZyN�, Work Phone: 1 7 Former Student: Yes 1 to If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: G 'luek 7 q0 C� Pistol License Number: Secondary Weapon Type and Caliber: P—S n 10y :ib State of Issue: Expiration Date: COURSEDATE: �W� It COURSE NAME: L Wa &L rh H't JG..jCw[ Pre Requisites Met: es' No Emergency Name: _�c 7`c a.. i3F.rrui Emergency Phone: 3 5 Z) on LFIMilitary Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LEIMilitary: Select one of the following options. Certificate of Good Conduct (from your local Po ice Department }n Active Duty Police Id; Police DepUUnit C—A 1 o 'c a Badge Active Duty Military, (No ID copy required) Unit Branch of Service If Civilian Provide Either: Pistol License No. (any stale) or CCW Permit No. Exp, Date_ State of Issue A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAO PAGE FOR UPDATED INFORMATION A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Acplication for Training Viking Tactics, Inc. I Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name MI Last Name t I-> Email Address: fw t. Date of Birth: to J e- Ir Age: Home Address: i r''t� hr G l -J. City: 1A r_i�� Stated Zip Occupation 04f «i Military or LE Affiliation 1. Rank: Work Address: City: C'_« P f State Zip r_= r Home Phone t `i a f,�� Work Phone: L7) Former Student No If yes, provide prior dates: tom_ Ma Weapon Information: f� If Civilian, Pistol License Lber, Stat f Issuance and Expiration Date: Primary Weapon Type and Caliber: T Pistol License Number: Secondary Weapon Type and Caliber. ft, C-C— State of Issue: Expiration Dale: COURSE DATE: Mt LS' r' COURSE NAME: �i�,4 z _k/ Pre Requisites Met:t &l No Emergency Name: fG Y.�. ,r s Emergency Phone: f 7 Cv_SD S ell" LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. 4 Certificate of Good Conduct (from your local Police Department) V Active Duty Police Id; Police Dept/Unit C, r: ,J Badge V Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: V Pistol License No. (any state) or CCW Permit No. Exp. Date State of Issue V A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. it Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. I Deposit is waived for PO remittances and M'1 ders. Payment method: Check Purchase Order Credit Card Amount (add 5% to If paying by credit card: AKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: LExpi rat[onrDateof ation: Viking Tactics, Inc. Card: 3725 Heatherbrooke Drive ber: Fayetteville, NC 28306 Card: Code: Viking Tactics, Inc. 4C 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (9`10)425-0700 www.ViKINGTACTICS.COM Registration and Armlication for Training Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ]TAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name R "k> 0�7 MI t-' Last Name Email Address: CA�_r f f-._ .'s ,.J C�L1 Date of Birth: l Age: Y\ Home Address: 3 c uo 'jc- R�f\R- City: Q-A mist— Zip lLa2 Occupation. cF ic R Nlilitary or LE Affiliation: LAw F A [l r,r �P->\ Rank: DET&C t UE Work Address: 3 C c c_ S City: State Zip �_j Home Phone l h 5 O- t,` Work Phone: 31 1 s t Former Student: Yes A@ If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber. A k `t Pistol License Number. Secondary Weapon Type and Caliber. '-1 a "C­ ��r +,d State of Issue: Expiration Date: COURSE DATE: S ll l o COURSE NAME: G G u- 6 1-.�2 <k�j"i Pre Requisites Met:(j No Emergency Name: Emergency Phone: 3 l l 101 a� 5 LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. 1 Certificate of Good Conduct (from your local Police Department) r Active Duty Police Id; Police Dept/Unit C Afz M0- ?64 Badge !J b t Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: 1 Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. V Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. V Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. TM 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. 1 Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name MI Z Last Name Email Address C (y1t?ueC0C XfftCk i C\ qoV Date of Birth: 11 I `b I 'll Age: 1Z Home Address: 0 n 3 0 City: LC 00 State A Zip�33 Occupation: I;C 'U-4 Military or LE Affiliation: Rank: Work Address: 3 Cjty: C'arr_ 0 1 State Zip L11� 3Z- Home Phone 37 bS Work Phone: (T) L- O\SJi� Former Student; Yes/ 0 If yes, provide prior dates; f Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: 1 O Pistol License Number: Secondary Weapon Type and Calibe State of Issue: Expiration Date: COURSE DATE: COURSE NAME: L e c� «S Y�: Q n a \v-+� g Pre Requisites Met Yes 1 No Emergency Name: Q— Z Emergency Phone: Credentialing Policy: VTAC has a strict credentialing policy. A photocopy of ONE of the following must be emailed lambOvikingtaclics.coml faxed (910 -987- 5983), or mailed LISPS: t Certificate of Good Conduct (from your I I Police Depa met 0 Active Duty Police Id; Police DepUU nit C MQ_' 1`VPS� Badge# T Active Duty Military Id; Unit Branch of Service If Civilian Provide Either: r Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue V A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. LE/Police Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the above will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant Submission of this application indicates your clear understanding of this requirement. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION r. A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. t Course Cancellation Policy: We require the full tuition up front to reserve your slot If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. C Deposit is waived for PO remittances and Mil Orders. s If submitting online, fax or email, deposit or payment in full must be made within 5 days of submission. Payment method: Check Purchase Order Credit Card _Amount If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. Payment Information: Send Payments to: Name on Credit Card: Viking Taclics, Inc. Credit Card Number: 3725 Heatherbrooke Drive Expiration Date of Card: Code: Fayetteville, NC 28306 Viking Tactics, Inc. TM 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 4C FAX: (910) 425 -0700 vvoew.VIKINGTACTICS.COM Registration and Application for Training Viking Tactics, Inc. 1 Team VTAC, Inc. IN ACCORDANCE WITH [TAR REGULATIONS, ONLY U.S. CITIZENS MLL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name MI D. Last Name Email Address: r -)N 1;!2. Oy y Date of Birth: S lge:_Z4 Home Address: Suua2E City: r�,a2rn�z State Zip Occupation: PoidC- l C Military or LE Affiliation: 6 PP Rank: Work Address: 3 Ccv,e Sauwc State Zip Y&o _T Home Phone 4� (x(,33 Work Phone: Former Student: Yes No If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber. +e- nw- OU d-0 ar Pistol License Number. Secondary Weapon Type and Caliber r►voi_t_d? yp e A, State of Issue: Expiration Date: COURSE DATE: 5 O1 D COURSE NAME: .���04" Pre Requisites Met: Yes No Emergency Name: C,Ae"*_Z Pale r Emergency Phone: 0 LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy, A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. V Cerlfcate of Good Conduct (from your Ioc�l Police Depagent) t Active Duty Police Id; Police DeptlUnit ►t2 1'�,� Badge# 62dw Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue 1 A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. v Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. V Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. (Note an additional 5% will be added to course fee for processing CC payments)' Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number. '8" Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VlKINGTACTICS.COM Registration and Application for Trainin Viking Tactics, Inc. 1 Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name �CI5401. r MI t Last Name �I Email Address: J I6A Q �rwr, tir9rl Date of Birth: `f I 1 73 Age: 3 6 Home Address; 7 5a l'l City: �I State Zip Occupation: Military or LE Affiliation: Plic e Rank: o��tia Work Address: 3 C v t City: �xrrYlA State Zp 1 /4ca ?4 Home Phone S77 l os7 Work Phone: 15'71 Former Student: Yes 16 If yes, provide prior dates: Weapon Information: It Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber. L ck RC vet 41Z LS i ;L�Z3 Pistol License Number. Secondary Weapon Type and Caliber. State of Issue: Expiration Date: 6TV 5` 1/1 COURSE DATE: COURSE NAME: G 5 4"i N Pre Requisites Met: Yes No Emergency Name: 7 h L.40 Emergency Phone: 51 OF LElMiilitary Only Courses: Must include credentials verifying active LE status or active Military D. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. t Certificate of Good Conduct (from your local, olice Dep C'. t' Active Du e Police Id; Police De p tlUnit L'tr`+ k .?1 Badge u Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: 't Pistol License No. (any state) or CCW Permit No. Exp. Date State of Issue t A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. t Course Cancellation Policy: We require the full tuition up front to reserve your slot, If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. t Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. (Note an additional 5% will be added to course fee for processing CC payments) Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: e 1 Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 vwdw.ViKINGTACTICS.COM Registration and Application for Trainin�g Viking Tactics, Inc. I Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PART IN VTAC COURSES First Name /C MI T Last Name Email Address: %'.n 0tV___ Date of Birth: 3° 7z Age: Z_T Home Address: /l q ?7 51,L VXA A.DU ag City: F 1 54 r-2 5 S tate r ,1 Zip q c°31 Occupation: Poke D91c? r Military or LE Affiliation: �f Lcy" X //c�e_ Rank: ro41' Work Address: City: State Zip Y &Q 3 Home Phone Li? sic, 1I 9 Work Phone: (3L7) 5 c�-So 0 Former Student: Yes /�p If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber: ,�l ck Kwe, ,M 5 �a 3 Pistol License Number. Secondary Weapon Type and Caliber: G%o C.x- 'R `/D State of Issue: Expiration Date: COURSE DATE: 11 COURSE NAME: L ra.c4rs J 14 5e, kA Pre Requisites Met: Yes I No Emergency Name: 5 Emergency Phone: 317 S 7c- y o 2 3 LElMilltary Only Courses: Must Include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentlaling Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. V Certificate of Good Conduct (from your local Police Department) T Active Duty Police Id; Police Dept/Unit Badge "t Active Duty Military; (No ID copy required) Unit Branch of Service It Civilian Provide Either Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue I A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. t Course Cancellation Policy: We require the full tuition up front to reserve your slot If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. t< Deposit is waived for PO remittances and YiI Orders, Payment method: Check Purchase ORW Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc, "(Note an additional 5 %b will be added to course fee for processing CC payments) Send Payments to: Payment Information: Viking Tactics, Inc, Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. n 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Arclication for Training. Viking Tactics, Inc.1 Team VTAC, Inc. IN ACCORDANCE WITH [TAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name .5 /yAIV MI Last Name VA Al A T TE,f Email Address: S VAA1A1 i r k c A RM E c /N. Date of Birth: q1 1 7 1 7z Age: Home Address: ,SAGO 1409 )a6Ad CT City: C .,4,CMEc State Zip Occupation: POC I c E Military or LE Affiliation: USM C Rank: Work Address: 3 Cf✓ic -So. City: CAMEL- State 1W Zip S160 Z Home Phone 17 .SG y 113 Work Phone: 2 1 7 57 2 S-6 a Former Student: Yes /4I j If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber. G loc k 22- y0 Pistol License Number. Secondary Weapon Type and Caliber. /4 K /f ZZ3 State of Issue: Expiration Date: COURSE DATE: 5_ 10Y //0 COURSE NAME: Lr4�� P .T A, Sl. ,r Pre Requisites Met: Yes 1 No Emergency Name: /I-- fA* Vim^ r -111 1 Emergency Phone: 317 3'l `l /076 LElMilttery Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptioos. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentlaling Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. V Certificate of Good Conduct (from your local Police Department) 2 9 Z 3 7 Active Duty Police Id; Police DepVUnn e g r M c t f o I. Badge 1 Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either. 3 Pistol License No. (any state) or CCW Permit No. Exp. Date State of Issue I A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION 4 A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. v Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition, If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. T Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments)- Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: 9 Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKINGTACTICS.COM Registration and Aooiication for Training Viking Tactics, Inc. 1 Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CI WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name Gfe f MI Last Name Email Address: 9f layeal/ Qzadz,orri Date of Birth: 0 3 1 Age: Z_ 6 Home Address: 1 11 1 4 sr'4 210 City: /:VSAM( State 'V Zip y�'O3 Occupation: ACK 0 Military or LE Affiliation: Rank: Work Address: 3 GUrc� �9�, k City: (fX State -'`Z Zip V,03 Home Phone 1 V13 Z 7Z� Work Phone: Former Student: Yes& If yes, provide prior dates: Weapon Information. If Civilian, Pistol License Number, Slate of Issuance and Expiration Date: Primary Weapon Type and Caliber. L�� ZZ 6 C� 1 Pistol License Number. Secondary Weapon Type and Caliber: ek b CG State of Issue: Expiration Date: COURSE DATE: J 0 COURSE NAME: CV MMF M Pre- Requisites Met: I No Emergency Name: (�,2E6 o,� l� N Emergency Phone, Credentialing Policy: VTAC has a strict credentialing policy. A photocopy of ONE of the following must be emailed (lambovikingtactics.com) faxed (910-987 5983), or mailed LISPS: T Certificate of Good Conduct (from your local Police Department) c Active Duty Police Id; Police Dept/Unit CG /?7LTL �UGIL� Badge# z Active Duty Military Id; Unit Branch of Service If Civilian Provide Either: T Pistol License No. (any state) or CCW Permit No. Exp. Date_ State of Issue t A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. LE/Police Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the above will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. r Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. V Deposit is waived for PO remittances and Mil Orders. V If submitting online, fax or email, deposit or payment in full must be made within 5 days of submission. Payment method: Check Purchase Or Credit. Card Amount If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. Payment Information: Send Payments to: Name on Credit Card: Viking Tactics, Inc. Credit Card Number: 3725 Heatherbrooke Drive Expiration Date of Card: Code: Fayetteville, NC 28306 Viking Tactics, Inc. ,M 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www.VIKIN GTACTICS.COM Registration and Application for Trainin Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH TAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name' 41 S r wrT M I b- Last Name Lo Q G Email Address: StO T��6)Ccsnne.< IA -!R y Date of Birth: 1 I] Age: Home Address: 5 k" 7t5V- ST-, C& A4—'_1 tSF >ZS State Zip.. j)38 Occupation: poll t✓ O�%fL�e2_ Milita or LE Affiliation: l`C� Rank: Wn an E,l 4 P ry Work Address: 2; C; vie- S4 to ee- City: 04- a- AtC State Zip L41LO 3 Home Phone afl)g 1121A Work Phone: 7) M Former Student: Yesyes, provide prior dates: Weapon Information: I If Civilian, Pistol License Number, State of Issuance and Expiration Date: Primary Weapon Type and Caliber; o &k 4 L�v n 1, �l�rr Pistol License Number: Secondary Weapon Type and Calib Z_J 5 1- bee State of Issue: Expiration Date: COURSE DATE: S COURSE NAME: Lk4A 6I4' 0 olili Y Mi rabSET 5* re- Requisites Met: Yes I No Emergency Name: n115 rQ "3 L M'00 EmUnencyPhone: 2,i: 77 1 14 ^IIPI LEIMilitary Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LEIMilitary: Select one of the following options. I Certificate of Good Conduct (from your loc l Police Department t l" 8 Active Duty Police Id; Police DeptlUnit 0 A964�C� d t 1 f U- Badge 0 0 ti Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: Pistol License No. (any state) or CCW Permit No. Exp, Date_ State of Issue V A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION t A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. V Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. 1 Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card: MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. '(Note an additional 5% will be added to course fee for processing CC payments)" Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: Viking Tactics, Inc. 3725 Heatherbrooke Drive Fayetteville, NC 28306 -9718 PHONE: (910) 987 -5983 FAX: (910) 425 -0700 www, VI KI NGTACTICS.COM Registration and Application for Tra ining Viking Tactics, Inc. Team VTAC, Inc. IN ACCORDANCE WITH ITAR REGULATIONS, ONLY U.S. CITIZENS WILL BE ACCEPTED TO PARTICIPATE IN VTAC COURSES First Name r Danr^4 MI Last Name Email Address: i f X+ Cu_A Q Date of Birth: 0q 7,5 0 Age: Home Address: 1'Zgy �QCSt� -t l� City: rm Stat Occupation: RLI ick 'e.2 o Military or LE Affiliation; IJ AF \JA+ Rank: Work Address: .3 C_wic. S4. City: CDC State A. Zip t._3Z. Home Phone (MI) E/-5 02-9( Work Phone: (3/1) 57/ Z5 Former Student: Yevo If yes, provide prior dates: Weapon Information: If Civilian, Pistol License Number, State of issuance and Expiration Date: Primary Weapon Type and Caliber: ;7 O 1 41 �af W z2 Pistol License Number. Secondary Weapon Type and Caliber, State of Issue: Expiration Date: COURSE DATE: E COURSE NAME: Czm6 AAlaedz;6 4& Pre- Requisites Met: Yes 1 No Emergency Name: Emergency Phone: LE/Military Only Courses: Must include credentials verifying active LE status or active Military ID. An application without one of the options below will be rejected. There are NO exceptions. VTAC reserves the absolute right to refuse training for any reason whatsoever to any applicant. Submission of this application indicates your clear understanding of this requirement. Credentialing Policy: VTAC has a strict credentialing policy. A photocopy or completion of ONE of the following options should accompany your application. LE/Military: Select one of the following options. Certificate of Good Conduct (from your local olive Dep lm t) Active Duty Police Id; Police Dept/Unit JP Badge ZO Z Active Duty Military; (No ID copy required) Unit Branch of Service If Civilian Provide Either: Pistol License No, (any state) or CCW Permit No. Exp. Date State of Issue A current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity. Payment Information: SEE VTAC INSTRUCTION PAGE AND FAQ PAGE FOR UPDATED INFORMATION A deposit is required to reserve your seat. Refer to the Course Announcement for the amount. Course Cancellation Policy: We require the full tuition up front to reserve your slot. If you cancel outside of 30 days, we will refund 100% of your tuition. If you cancel inside of 30 days, and we cannot fill your slot, we retain 50% of your tuition. Deposit is waived for PO remittances and Mil Orders. Payment method: Check Purchase Order Credit Card Amount (add 5% to course fee) If paying by credit card; MAKE CHECKS PAYABLE TO: Viking Tactics, Inc. "(Note an additional 5% will be added to course fee for processing CC payments) Send Payments to: Payment Information: Viking Tactics, Inc. Name on Credit Card: 3725 Heatherbrooke Drive Credit Card Number: Fayetteville, NC 28306 Expiration Date of Card: Code: C 4 INDIANA RETAIL TAX EXEMPT PAGE 1 1 o II C ar el CERTIFICATE NO. 003120155 002 0 1 f 1�l 1i PURCHASE ORDER NUMBER 1?cIjAce Department FEDERAL EXCISE TAX EXEMPT 6 35- 60000972 91 356 3 QN& CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL INDIANA 46032-2584. VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY SIATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 i PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION F'ebruary 16, 2010 training VENDOR 'VIfiking Tactics, Inc. SHIP City of Calmnel Police Department 3725 Beatherbrooke Drive TO 3 Civic Square Fayetteville, NC 28306 -9718 Carmel., IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Leadership in Shadows seminar for Sgt. Ryan Meyer, 85.00 375,00 let. Bob Locke, Officer DJ Schoeff, Officer Chtts Dunlap and Officer Mark Paris on May 11, 2010 in Westfield, IN (I e N r t� Send Invoice To: City of Carmel Poli ATTN: Teresa Anderson 3 Civic Square Carmel, IN 46032 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT 210 570 cont ed fund PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. C.O.B. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chie o f D olice AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2 1 �j CLERK TREASURER DOCUMENT CONTROL NO A.P. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT NO. ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO## or INVOICE NO. ACCT##ITITLE AMOUNT DEPT, I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except.___ 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund C1 0 INDIANA RETAIL TAX EXEMPT PAGE of anal CERTIFICATE NO. 003120155 002 0 of �i \���1//// CS.+s �a. PURCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 3 OLE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION February 5 2010 training VENDOR Viking Tactics, Inc. SHIP City of Cisalel Police Depart nt 3725 Heatherbrooke Drive TO 3 Civic Square 'Fayetteville, HC 28306 Carmel, IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Fight Fighter school for Sgt. Brady Myers 600.00 on march 25 27, 2010 in Fayetteville, NC 4 xl 1 4 4 s_ Send Invoice To: City 66 Carmel PO r as j ATTN: Teresa AnderSI 3 Civic Square Cammik, IN 460032 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 210 570 coast edd fund 'PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. f NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. C.O.D, SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �I.:l`.,9,- }r: -r SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99 ACTS 1945 TITLE Chief or Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. n CLERK- TREASURER DOCUMENT CONTROL NO M COPY SIGN AND RETURN TO CLERK OFFICE VJUCHER NO. WARRANT NO.-.--- ALLOWED 20 IN THE SUM OF ON ACCOUNT APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except i 20 Signature--- I Title Cost distribution ledger classification if claim paid motor vehicle highway fund INDIANA RETAIL TAX EXEMPT PAGE C1'q o I' Carmel CERTIFICATE NO. 00312D155 OD2 0 1 1+�. �i PURCHASE ORDER NUM6ER Police Department F FEDERAL EXCISE TAX EXEMPT 35- 60000972 2 1 337 3QN(v CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, MP CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF•CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION January 29, 2010 training Viki Tactics, Inc. VENDOR SHIP City of Carmel P Department 3725 Heatherbrooke Drive TO 3 Civic Square Fayettevifi3le, NC 28306 Carmel, IN 46032 CONFIRMATION BLANKET I CONTRACT PAYMENT TERMS FREIGHT QUANT11 I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Leaderhhip in the Hhhdows and Combat Mindseat 75.00 seminar for Lt. Charlie Harting on May 11, 2010 in Westfield, IN t 6 J rT Y' e• a City of Carmel Pal hr 4 J Send Invoice To: ATTN. Teresa Anderso 3 Civic Square Carmel, IN 46032 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT r I PROJECT ACCOUNT AMOUNT 210 570 cont ed fund PAYMENT AP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE, AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENTTO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. !�f'll��.1 r�!✓i PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. r' THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2 .L CLERK- TREASURER DOCUMENT CONTROL NO. A. COPY SIGN AND RETURN TO CLERK'S OFFICE Vn- UCHER NO. WARRANT NO.- ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #trlTt_E AMOUNT DEPT. 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except�,�____ 20 j Signature Title j Cost distribution ledger classification if claim paid motor vehicle highway fund I INDIANA RETAIL TAX EXEMPT PAGE C .I� Carmel CERTIFICATE NO. 003120155 002 0 1 of 1 1a o J+• PURCHASE ORDER NUMBER r Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 21837 39NE.CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, AR CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO, DESCRIPTION Harch 1, 2010 training VENDOR Viking.T:actics, Inc. SHIP City of Carmel Police Depar=ent 3725 Heatherbrooke Drive TO 3 Civic Squarew Fayettevdil &ip, NC 26306 -9718 Cammel, IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Leadership in the Shatows school. for Officer 751.00 150.00 Curtis Scott and Det, Mike Pitman on May 11, 2010 in Westfield, IN a A-z 4 City of Carmel Poee Send Invoice To: ATTN: Teresa Anders r 3 Civic Oqu>are Carmel, IN 46032 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 9 10 570 coast ed nd PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. SHIP REPAID. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police_ AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. DOCUMENT CONTROL NO. 8 A47. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO._ WARRANT NO._._...._— ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #rTIT'LE AMOUNT DEPT. I hereby certify that the attached invoice(s), or, bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except_ 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund t` INDIANA RETAIL TAX EXEMPT PAGE II Cojil me CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER COty 1i 1111 Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 1 L 7 NE1CIVIC SQUARE THIS NUMBER MUST APPEAR ON VOICES, AIP CA MECINDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, P IN ACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION Mare 5 20M tra.inine VENDOR Viking Tactics, Inc.. SHIP Cityo6fCCarmel,Police Department 3725 Heatherbraake Drive TO 3 Civic Squarer Fayetteville, NC 28306 Carl, IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION CQB Training for Officer Todd Clarj., Sgt, Shane 680.60 9,160.00 Collins, Det. GreggDawson, Oddicer Chloe Dunlap, Offterr Ben Fishers Officer Will Giltrert, Sgt. Ryan Jellison, Det. Bob Locke, Officer Scott .Long, Officer Greg Loy,�q, t. Adana Miller, Sgt. Bfady Myer ,��i s, Det. Mike Pitman, e C�-t S aw d Officer Shane VanN 0. M a 1�2., N, 4 4 4n° a the Muscatat�u(kk nT Ira inigg Cen1:e ,W 2 free b, sestimate'I` q -14 $0 q ro sy.' Send Invoice To: City of Cannel Pot ATTN: Teresa Anderso 3 Civic Square Carmel, IN 46032 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 210 570 cont eddfund PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SKIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ll ORDERED Ill fd 4 1 b s.r A PURCHASE ORDER NUMBER MUST APPEAR ON ALL ,r-� -L F 7 SHIPPING LABELS. 6 THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK- TREASURER DOCUMENT CONTROL NO. A. C SIGN AND RETURN TO CLERK'S OFFICE V`JUCHER NO. WARRANT NO. ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR 9 Board Members PO# or INVOICE NO, ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 2p Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Viking Tactics, Inc. Purchase Order N 21337F 21837F 21344F 21356F 21359F 21842F 3725 Heatherbrooke Drive Terms Fayetteville, NC 28306 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 3/13/10 22794 payment for trainin 2/18/10 21989 payment for trainin 2/18/10 21990 payMent for trainin 2/9/10 21666 payment for traiAin 600.00 3/13/10 22795 payment for trainin 3/13/10 22798 payment for trainin Total 11 060.00 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOI;CHER NO. WARRANT NO. ALLOWED 20 Viking Tactics, Inc. IN SUM OF 3725 Heatherbrooke Drive Fayetteville, NC 28306 11,060.00 ON ACCOUNT OF APPROPRIATION FOR co e fund Board Members Po# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 21359F 21989 570 300.00 bill(s) is (are) true and correct and that the 21356F 21990 570 375.00 materials or services itemized thereon for 21344F 21666 570 600.00 which charge is made were ordered and 21337F 22798 570 75 .00 received except 21837F 22795 570 150.00 21842F 22794 570 9,560.00 March 25 20 101 AL Y Signature Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund