Course 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.

* Required Information

Course Title*

Course Dates*

Your Name*

Rank

ID#

Agency Type*

Department/Agency*

Address*

City*, State* and Zip*

Contact Phone Number*

E-Mail Address*



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

Name

Phone Number

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 – IMPORTANT!

CREDIT CARD – INFORMATIONAL PURPOSES ONLY*:

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