Mobile Surveillance Training
Thursday, October 19, 2017
8:00 AM - 5:00 PM
Location: Ontario Police Department
Directions: 2500 S. Archibald Ave Ontario, CA 91761

Download Flyer

100 Class Limit

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)*


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

COST:  Members & Non Members $50