REGISTRATION FORM

Submitting this registration form does not guarantee a seat in the class.  Your enrollment in the course will be confirmed by e-mail.

COURSE TITLE:      

DATES:

NAME:  

RANK:  

ID#:  

AGENCY TYPE: Sworn Officer Military

DEPARTMENT/ AGENCY:

ADDRESS:   

CITY:

STATE:  

ZIP:

CONTACT NUMBER:  

E-MAIL ADDRESS:

If your department is paying please provide the name of your accounts payable contact person or training coordinator:

NAME:   

PHONE#:  

E-MAIL ADDRESS:

 It is the students responsibility to ensure that payment requests are submitted through their department. In most cases that requires submitting paper work at least 30 days before the course begins. In the alternative you may pay with personal funds and request departmental reimbursement following the training. 

METHOD OF PAYMENT:

CREDIT CARD: Please select Payment Method VISA MASTER CARD DEPARTMENT CHECK PERSONAL CHECK IMPORTANT

The agency of a "No-Show" (F.T.A.) where no notification is provided will be billed for full tuition.