Executive Operations Group Student Survey | Executive Operations Group

Name*

First Last

Your preferred Email address*

Mobile Phone*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Emergency Point of Contact*

The person to call in event of an emergency

First Last

Your Relationship to Emergency Point of Contact

Emergency Contact Phone Number*

Have you done any Pistol Training in the past year?*

Yes
No

Have you done any Survival Training in the past year?*

Yes
No

Have you done any combatives/hand-to-hand/martial arts training in the past year?*

Yes
No

Are you Right or Left Handed?*

Select your dominant hand

Right Handed
Left Handed

Are 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 Dominant
Left Eye Dominant

What 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?*

Yes
No

Please provide any information that may be helpful regarding your physical or health considerations

Driver's License

In addition to filling in the information below, please scan and email both sides of your driver's license to korbyholcomb@gmail.com or send pictures of both sides via text message to 931-307-9147.

Your Name as it appears on your Driver's License

Driver's License Number

Driver's Licenses Expiration Date

Driver's Licenses State or Province

By 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.

Yes
No

Referral

Please provide the name of one person you would refer to this course

First Last

Phone number of referral

Email of referral

Executive Operations Group: Student Registration Survey

Driver's License

Referral