LEOSA HR-218 RETIRED LAW ENFORCEMENT CONCEALED CARRY CERTIFICATION

• Students will be required to pass a firearm qualification
• A copy of valid NYS Pistol Permit.
• A copy of a current Retired Peace / Police Officer ID card from your former Department.
• Firearm, semi-auto or revolver with magazines or speed loader reloading device.
• A minimum of 50 rounds of ammunition
• Eye/ear protection.

By signing this application, I acknowledge that I have read and understand the rules, regulations, and policies of the Glen Cove PBA Pistol and Rifle Association. I understand that the primary purpose of my attendance at this event is to allow for convenient access to the facility primarily for firearms instruction and training. I also give the Glen Cove PBA Pistol and Rifle Association permission to collect information regarding the validity of my United States citizenship, criminal record, and pistol permit information. I have also answered all questions truthfully and to the best of my knowledge.

I understand that any false statements made herein will result in immediate termination of my membership and I may be reported to the appropriate governmental authorities for investigation and/or possible prosecution for wrongdoing under applicable law.