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Please enter the student information below as completely as possible.

First Name
Last Name
Title or Rank
Full Agency Name
( i.e. Los Angeles Police Department )
Address 1
Address 2
City
State or Province    Other: 
Zip or Postal Code
Country
Email

Each student's credentials will be emailed to the address given.

Phone
Fax
Cell or Other
PO Number
Email of Person Placing Order:
Email of person entering this order (if differnt than the Attendee address given).
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