Executive Operations Group: Student Registration Survey Name* First Last Your preferred Email address* Mobile Phone*Mailing Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Emergency Point of Contact*The person to call in event of an emergency First Last Your Relationship to Emergency Point of ContactEmergency Contact Phone Number*Have you done any Pistol Training in the past year?*YesNoHave you done any Survival Training in the past year?*YesNoHave you done any combatives/hand-to-hand/martial arts training in the past year?*YesNoAre you Right or Left Handed?*Select your dominant handRight HandedLeft HandedAre you Right or Left Eye Dominant?*Put your two hands out in front of you and make a triangle to peek through. With both eyes open, look through the triangle and center something such as a doorknob in the triangle. Close your left eye. If the object remains in view, you are right eye dominant. If closing your right eye keeps the object in view, you are left eye dominant.Right Eye DominantLeft Eye DominantWhat are your personal expectations for this course?*Do you have any physical or health conditions we should be aware of so that we can maximize your training experience?*YesNoPlease provide any information that may be helpful regarding your physical or health considerationsDriver's LicenseIn addition to filling in the information below, please scan and email both sides of your driver's license to firstname.lastname@example.org or send pictures of both sides via text message to 931-307-9147.Your Name as it appears on your Driver's LicenseDriver's License NumberDriver's Licenses Expiration DateDriver's Licenses State or ProvinceBy selecting "Yes" I am giving permission for Executive Operations Group to perform a background check*For your security and the security of all involved, we perform background checks on all attendees.YesNoReferralPlease provide the name of one person you would refer to this course First Last Phone number of referralEmail of referral This iframe contains the logic required to handle Ajax powered Gravity Forms.