Informant Development, Operations, & Management
Friday, November 5, 2021
8:00 AM - 5:00 PM
Location: Fullerton Public Library
Directions: 353 W Commonwealth Ave, Fullerton, CA 92832

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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:* (2 characters)

Zip Code:*

CONTACT INFORMATION
Work Phone: (include area code)*

Cell Phone: (include area code)
 
 Email Address:*
 
Law Enforcement Agency Email Address Required
IDENTIFYING INFORMATION*
Post ID#:   

Date of Birth:*
 
Gender* Male Female
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: *
From:

To:
 

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*

Law Enforcement Credentials Are Required at Registration
Choose your Membership Status



Cost per person: $50

Credit / Debit Card Information (all fields required)
Card Type

Cardholder's First Name

Cardholder's Last Name

Credit Card Number

Exp Date
(e.g.: 05/2022)
Security Code

 

Cardholder's Billing Street Address

Billing City

Billing State
(2-digit state code)
Billing Zip Code

Billing Country
(2-character country code)