STUDENT INFORMATION * RequiredFirst Name:* Last Name:* Middle Name:* Position/Title/Rank:* Permanent Address: (no P.O. Boxes)*City:*
CONTACT INFORMATIONPhone Work: (include area code)* Cell Phone: (include area code) Fax: (include area code) E-mail:* (Please Use Law Enforcement Agency Email Address)IDENTIFYING INFORMATION * Sworn Law Enforcement OfficerHispanic Non-Hispanic / LatinoPost ID#:Date of Birth (mm/dd/yy):* (For College Credit)
Birth State or Country:* Last 4 digits of social security # Gender* Male FemalePrevious Last Name (enter N/A if the same):*
YOUR AGENCY / ORGANIZATION NAME*
Local State Federal MilitaryAgency City:*
HIDTA TASKFORCE MEMBERYes No
PRICE: $225
Members and Non-Members
Law Enforcement Credentials Are Required at Registration