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Pistol/Rifle Range Application - Student

*Name:**
*Street Address:**
*City:**
*State:**
*ZIP Code:**
*Phone Number:**
*Date:**	Monday, September 20, 2010
*Number of Weapons:**
*Type of Weapons:**
*Storage required?:**	Yes No

*REQUIRED FIELDS

Before selecting 'Submit', please print this form (select 'File' from the top left browser bar and then 'Print' from the drop-down list) and sign the paper copy on the line below. The signed copy must be provided to the guard at the entrance to the Academy.

Signature______________________________________________

UNITED STATES COAST GUARD ACADEMY
31 MOHEGAN AVENUE
NEW LONDON, CT 06320
ADMISSIONS HOTLINE: 800.883.USCG (8724)

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