NAME:________________________________ DATE:________________________

PHONE:_____________________ EMERGENCY PHONE:___________________

email address: ____________________

This is my application for the Ben Avery Shooting Facility's Line Safety Officer Program. Line Safety Officers operate the Main Range for the Arizona Game and Fish Department, and provide a valuable public service.

 Do you have experience as a volunteer? Please describe:

Do you have any experience/training as a firearms safety officer or Range Officer? Please describe amount, type and location.

When would you prefer to perform your Line Safety Officer duties?