Waiting List Registration

Covert Tactical Thinking
Monday, January 29, 2018
8:00 AM - 5:00 PM
Location: Kings Co Government Center
Directions: 1400 W Lacey Blvd Bldg #1, Hanford, CA 93230

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Class Limit 65


STUDENT INFORMATION * Required
First Name:*

Last Name:*

Middle Name:
 

Position/Title/Rank:*


YOUR AGENCY / ORGANIZATION NAME*

Work Address*

 
Address 2
 
City:*

State:*

Zip Code:*


CONTACT INFORMATION
Work Phone: (include area code)*

Contact Phone: (include area code)*

Cell Phone: (include area code)
 
 
E-mail:*
 
(Please Use Law Enforcement Agency Email Address)

IDENTIFYING INFORMATION*
Post ID#:   

Date of Birth (mm/dd/yy):*
 
Gender* Male Female
Last four digits of Social Security:*

 

Previous Last Name (enter N/A if the same):



HIGH SCHOOL LAST ATTENDED*

Name of High School*
 
County*
 
State (or Country if outside U.S.)*
 
Years Attended*
 -  
Year Graduated*
 

High School Graduation Status*
 

WHEN DID YOUR PRESENT STAY IN CALIFORNIA BEGIN?*

Approximate date you arrived in California? Enter birth date if always in CA (mm/dd/yy)*





 Law Enforcement Credentials Are Required at Registration
Members $35    Non-Members $45
Free for CVCHIDTA Personnel