LAW ENFORCEMENT MANAGEMENT INSTITUTE OF TEXAS
Office of Law Enforcement Training
Sam Houston State University/CJC
Huntsville, Texas 77341-2417
Tel: 936-294-4461/3497 Fax: 936-294-4125
www.LEMITONLINE.org
REGISTRATION FORM FOR: Office of Law Enforcement Training
Please print or type and fax back to (936)294-4125, attn: Tara Crumpler
Full Name: ______________________________________________________
Preferred First Name (for name tag/tent): ______________________________
Title: ___________________________ Gender______________
Social Security Number: ____________________________________________
Date of Birth (mo/day/yr): ___________________________________________
Agency Phone: ___________________ Agency Fax: _____________________
Department Name: _______________________________________________
Address: _________________________________________________________
City: ______________________________ State: ______ ZIP: ______________
County: ______________________ E-mail (if you would like to receive other OLET training announcements): ____________________________
Number of officers in your department____________________
Education (check one):
I would like to register for the following OLET program(s) indicated below:
(please write in the course information you are requesting, you may register for more than one)
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Signature of officer Date
Note: Please return this form via fax as soon as possible to guarantee a seat in the class of your choice. You will receive a confirmation letter for the course upon receipt of registration form, please give one week for this confirmation letter to be mailed to you.
Payment Information: PLEASE MARK ONE OF THE FOLLOWING OPTIONS
You may pay by cash or check, credit card, or by invoicing your agency. Please read below.
1. You may pay by cash, check, or credit card at the door the morning of the first day of the course.
Or you may mail in your cash or check either with your registration form or separately with a copy of your registration form so we know what the payment is for.
If you choose to mail in your payment in, please use the below address.
The Office of Law Enforcement Training, Sam Houston State University
Attn. Tara Crumpler
912 15th Street
Huntsville, Texas 77340
2. IF YOU WISH TO PAY BY INVOICE AND WILL BE BILLING YOUR DEPARTMENT, FAX YOUR REGISTRATION FORM TO (936) 294-4125 AND YOU OR SOMEONE AT YOUR AGENCY MUST CALL TARA CRUMPLER AT (936)-294-3497/3344 AND PROVIDE THE APPROPRIATE INFORMATION PRIOR TO THE FIRST DAY OF THE CLASS
3. If you desire to pay by credit card, you may pay by one of the following options:
- Pay the morning of the first day of the course
- Mail this registration form and sheet to the above address with the credit card information filled in below.
- Fax in your registration form and follow up with a call to Tara Crumpler prepared to give your card information over the phone.
- Fax in the registration form along with this sheet with the credit card information filled in below
PLEASE MARK ONE OF THE FOLLOWING OPTIONS.
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___ Payment Enclosed (cash or personal or agency check payable to “SHSU-OLET)
___Personal or Agency Check to be mailed in at later time (if invoicing, please call Tara at (936-294-3497)
____Credit card information included: Credit Card Account # ________________________________ Exp. Date__________
Visa_______ MasterCard _________
Auth. Code (3 digits on the reverse side of the card on the right side of the authorization signature block) _________
___Will call to provide credit card information (call Tara at 936-294-3497)
___Will pay cash, check, or credit card at the door on the first morning of the course