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In-Service Registration

Applicant Information: All fields are required
Name (Last, First):
Rank:
Department:
Department Street Address 1:
Department Street Address 2:
Department City, State, Zip:
Department Telephone:
Home Address 1:
Home Address 2:
Home City, State, Zip:
Home Phone:
 
Email:

Supply the following information relating to the school:
Name of School:
Date(s) of School:
Chief's Name:

Form Submission:
After submission, confirmation will be sent to the Chief of Police for your department

 
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