Waiting List Registration
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Stress Management for Today's Policing
Monday, June 10, 2019
8:00 am - 5:00 pm
Location: Bernalillo County SO Training Academy
Directions: Albuquerque, NM

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STUDENT INFORMATION
 
* required
First Name:
*

Last Name:
*

Position/Title/Rank:
*

Sworn Law Enforcement *
Non-Sworn Law Enforcement *


Phone Work: (e.g. ###-###-#### - ext)*

Cell Phone: (include area code)

E-mail:
* (Agency Email Address Preferred )

Please re-type your email address: *

Last 4 of SS#: *


ARE YOU A CURRENT HIDTA
INITIATIVE MEMBER?

Yes No *
If yes, select your Initiative *:


 

AGENCY / ORGANIZATION NAME

Agency City:*
 
County: *
 

Agency State:* 
(ie: NM)
  Agency Zip code:*

AGENCY / ORGANIZATION TYPE
Local State Federal Military
Other (please provide details)


SUPERVISOR INFORMATION
(For Law Enforcement Status Verification)
Full Name *

Phone Work: (e.g. ###-###-#### - ext) *

E-mail: *

     

 Credentials Required at Registration