REGISTRANT *required 

First Name: *

Last Name: *

Position/Title/Rank: *

AGENCY / ORGANIZATION
Agency/Organization Name: *

Law Enforcement
Other (enter below)

OPTIONAL NOTIFICATION
Training Coordinator Name

Training Coordinator E-mail
 

CONTACT INFORMATION
(for registration purposes only)
Phone Work: (include area code) *

Cell Phone: (include area code)

E-mail (must be actual students e-mail): *


AGENCY / ORGANIZATION ADDRESS
Address 1: *

Address 2:

City: *

County:*
 -Select County-AlamedaAlpineAmadorButteCalaverasColusaContra CostaDel NorteEl DoradoFresnoGlennHumboldtImperialInyoKernKingsLakeLassenLos AngelesMaderaMarinMariposaMendocinoMercedModocMonoMontereyNapaNevadaOrangePlacerPlumasRiversideSacramentoSan BenitoSan BernardinoSan DiegoSan FranciscoSan JoaquinSan Luis ObispoSan MateoSanta BarbaraSanta ClaraSanta CruzShastaSierraSiskiyouSolanoSonomaStanislausSutterTehamaTrinityTulareTuolumneVenturaYoloYubaOther

State: *

Zip code: *