FORM A (Renewal APPLICATION)

As a renewal applicant to IROCC, this form will need to be completed in full and paid online at completion

If any of the personal Information listed below has changed, please fill out this information change form to update your member profile.

First Name

Middle Initial

Maiden Name

Last Name

Date of Birth

Gender

FOID Card Number

Legal Residence

City

State

Zip Code

County

Email Address

Primary Phone

Secondary Phone

Firearm Type(s) You Intend to Qualify With

Agencies You Retired/Seperated From

Start Date

End Date

Agencies You Retired/Seperated From

Start Date

End Date

Agencies You Retired/Seperated From

Start Date

End Date

Please confirm before advancing

I Confirm that I Am Applying for an IROCC Certification and am of sound body and mind