Blaster Certification Application


Register/Update Account

Urgent! Please verify and update email address before submitting an application. Permits will be sent to the email provided below.


**Attn New Registrants: Be sure you enter the first and last name as you want them to appear on the permit.

Last Name of Applicant:
 
First Name of Applicant:
 
Middle Initial of Blaster Applicant:


U.S. Citizen?


Social Security Number:
  (XXX-XX-XXXX)
Date of Birth:
 (MM/DD/YYYY)
Home Phone Number:

Work Phone Number:


Mailing Address:
 
Mailing Address Line 2:

City:

State:

Zip Code:
 

Email Address:
 
Password:
  
Confirm Password:
 
Password Question:

Answer:
 


Password must be at least:
-8 character minimum
-12 character maximum
-1 uppercase
-1 lowercase
-1 number

For additional security, please check the checkbox below (and complete any puzzle prompts you may receive).