law enforcement training center - NC DPS
LAW ENFORCEMENT TRAINING CENTER MCDOWELL TECHNICAL COMMUNITY COLLEGE 54 College Drive, Marion, NC 28752
PRE-REGISTRATION FORM
TITLE OF CLASS: ______________________________________________________________ DATE(S) OF CLASS: ____________________________________________________________ TIMES OF CLASS: ______________________________________________________________ STUDENT NAME(S)
POSITION(S):
_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ (TO LIST ADDITIONAL STUDENTS, PLEASE ATTACH AN ADDITIONAL PAGE) AGENCY: _______________________________________ AGENCY ADDRESS: ________________________________________________ _____________________________________________________________________ AGENCY PHONE NUMBER: ________________________________________ PERSON AUTHORIZING NAME: ____________________________________ PERSON AUTHORIZING TITLE: ____________________________________ PERSON AUTHORIZING SIGNATURE: ______________________________ DATE OF AUTHORIZATION: ________________________________________ EMAIL ADDRESS OF PERSON AUTHORIZING: _______________________ _______________________________________________________ UPON SUMBITTING THIS FORM TO DIRECTOR STACY BUFF, THE AUTHORIZING PERSON WILL BE NOTIFIED OF CONFIRMATION. SEND TO STACY BUFF, DIRECTOR OF LAW ENFORCEMENT TRAINING FAX: 828-659-9710 OR EMAIL: [email protected]
LETC125
PRE-REGISTRATION FORM
TITLE OF CLASS: ______________________________________________________________ DATE(S) OF CLASS: ____________________________________________________________ TIMES OF CLASS: ______________________________________________________________ STUDENT NAME(S)
POSITION(S):
_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ (TO LIST ADDITIONAL STUDENTS, PLEASE ATTACH AN ADDITIONAL PAGE) AGENCY: _______________________________________ AGENCY ADDRESS: ________________________________________________ _____________________________________________________________________ AGENCY PHONE NUMBER: ________________________________________ PERSON AUTHORIZING NAME: ____________________________________ PERSON AUTHORIZING TITLE: ____________________________________ PERSON AUTHORIZING SIGNATURE: ______________________________ DATE OF AUTHORIZATION: ________________________________________ EMAIL ADDRESS OF PERSON AUTHORIZING: _______________________ _______________________________________________________ UPON SUMBITTING THIS FORM TO DIRECTOR STACY BUFF, THE AUTHORIZING PERSON WILL BE NOTIFIED OF CONFIRMATION. SEND TO STACY BUFF, DIRECTOR OF LAW ENFORCEMENT TRAINING FAX: 828-659-9710 OR EMAIL: [email protected]
LETC125
