Dear Valued Customer, We have prepared ourselves in hopes of preparing you for a more secure and safe way

of living. Thank you for showing interest in attending one of our training seminars. We are dedicated to provide personal defense and security training for individuals and families through our In-Home Defense and Security Seminars; Basic Fire Arms and First Aid/CPR for the home and work place. Attached you will find a form to be filled out by each person attending the seminar, as wells as a wavier form. If you are paying for more than one attendee please mark the box that is listed (number of attendees) 1 of 2 or 1 of 3. You may use one check for multiple attendees but one form per person which you may make copies of this form for this purpose. In the event you do not have copying capabilities please write all information on separate pieces of paper for each attendee. This form along with waiver must be returned with full payment 7 days prior to the date of the seminar. For any questions in regards to these forms , payment, seminar content , or date and times please contact us at 717-855-3603. Please leave a message and we will return your call promptly. Return payment and forms to Block Home Defense and Security, 245 Stone Creek Drive, York, PA 17406. Make checks payable to Charles Pugh. Course Title: Course Location: 245 Stone Creek Drive, York, PA 17406 Course Date: Course Time:

Course Title: Course Location: 245 Stone Creek Drive, York, PA 17406

Course Date:

Course Time:

Attendee Information: Full Name: Address: Email: Phone Number:

Attendee #

of

Amount of Course Per Attendee:

Total Check Amount:

Check #:

Please make Check Payable to Charles Pugh. Mail payment and completed forms to: Block Home Defense and Security, 245 Stone Creek Drive, York, PA 17406.

Please circle any of the following if you wish to receive more information: Home Defense/Security Seminar First Aid/CPR In-Home Defense/Security Consultation Basic Fire Arms SCL2013215