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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
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Zip
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#FT Officers in Department
Registered participants who are unable to attend may submit a request for a substitution attendee no later than 7 days prior to event date. All attendance information will be reported to sponsoring agency. Lack of attendance by registered participants in COPS sponsored trainings may disqualify agencies from future COPS trainings.
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