Training Registration Form

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Course Title*

Course Date*

Rank/Title

Name*

Address

Agency/Organization

Direct Phone*

Alternate Phone

Email address*

Advertised or quoted Cost: $

Are you claiming a tuition discount?

YesNo

Name of discount program

Are you claiming veteran status?

YesNo

DD214

YesNo

Is this a recertification program?

YesNo

Current Driver’s License

YesNo

T shirt size

Remark

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