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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
Years of Service
Gender: Female Male
Please inform us of any food allergies:
Responsibility: Chief Executive Officer Commander / CEO Mid. Management Operations Level First Line Supervisor
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
Supervisor's Full Name
Supervisor's Email
() - Supervisor's Phone
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
Precinct
#FT Officers in Department
Course is $395 per person. One participant per agency per class.
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 the participant has already paid, he/she will be refunded half the cost of the registration fee if written notice of cancellation is received by the Program Coordinator no later than seven (7) business days prior to the program. No refunds are available after this date, but substitutions of attendees are permitted.
If no written cancellation is received and the participant does not attend the program, the participant or their agency will be required to pay 100% of the registration fee if the registration fee was not previously paid.
I have read and agree to the above policies.