Law Enforcement Department Form

Person of Contact Name *

First Name

Last Name

Deparment Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Select Course: *

RESPONSE TO ACTIVE SHOOTER / HOSTILE EVENT

ACTIVE SHOOTER / HOSTILE EVENT REFRESHER

BASIC PATROL OFFICER ENTRY COURSE

PATROL RIFLE COURSE

PATROL RIFLE ADVANCE COURSE

DEFENSIVE TACTICS / USE OF FORCE CERTIFICATION / YEARLY CERTIFICATION / RECERTIFICATION

FIREARMS YEARLY CERTIFICATION (HANDGUN / PATROL RIFLE / SHOTGUN)

POINT BLACK ENTERPRISES: PHALANX SHIELD COURSE

Date of Course

*IF TBD LEAVE EMPTY

MM

DD

YYYY