Last Name

First Name

MI

Preferred Name
(for name tag/tent)

Officer/Deputy Corporal Detective Sergeant Lieutenant Captain Major Deputy Chief/Chief Deputy Chief/Sheriff Other
Rank
      if other:

Title

PID#

Date Of Birth

() -
Participant Phone

Participant Email

Gender:     Female     Male

Please inform us of any food allergies:

Education:
    Less than AA or 60 hours
    AA or over 60 hours
    Bachelor's degree
    Master's degree
    Terminal degree

Ethnicity:
    Black
    Indian
    Hispanic
    Asian
    White / Anglo

Date Appointed / Elected:

Month / Year

Previous Department

Previous Position

Name of person replaced

Is this your first time to serve as chief of police in Texas?   Yes     No

If you are a first-time Texas police chief and have been appointed/elected after January 1, 1999, you are required to complete 80 hours of training within 24 months of your appointment/election: New Chief Development Program (40 hrs.) and Texas Police Chief Leadership Series (40 hrs.). Both classes are only offered by LEMIT.

Agency / Department

() -
Agency Phone

Agency Email

Mailing Address

City

AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
State

Zip

County

#FT Officers in Department

Course is $100 per person.

I will be paying by:

    Online by Credit Card or Electronic Check
    Paper Check/Purchase Order  (Check/PO # )

You will be contacted with payment information
once the minimum number of attendees has been reached.

If no notice of cancellation is received by the Program Coordinator prior to the date of the program, and the participant does not attend the program, the participant or their agency will be required to pay a $100 'NO-SHOW' fee.

I have read and agree to the above policies.