Class Registration

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Name:*

First Last

Email:*

Phone*

How Did You Hear About Piece Be With You?*

Choose Your Class Location & Date:*

How Many Seats Would you Like to Reserve?*

Please enter a number from 1 to 20.

Additional Items:

Piece Be With You Mug

Price: $9.00

Piece Be With You Tumbler

Price: $16.00

USCCA Book

Price: $30.00

Total:

Your lunch choices are:

- 2 slices of pizza
- Fried Flounder Sandwich
- Meatballs Parmigiana Sub
- Italian Sub

* Drink is included. Tip is NOT included.

Please list your selections for all guests below:

Legal Name of Attendee:*

Legal Name of Each Attendee:*

Please list all legal names of all attendees

Credit Card*

Cardholder Name

Card Details

Class Registration

Additional Items:

Self-Defense Coverage with Right to Bear

Self-Defense Coverage
with Right to Bear