Registration

Seminar Registration: Last seminar of the year.

2012 Schedule to be published at end of 2011.

		Seminar Name

		Number of Registrants

		First Name *		Last Name *

		Rank/Position

		Agency *		Street Address *

		City *		State *		Zip Code *

		E-mail Address *

		Contact Phone *

		Comments/Additional Registrants

		Registrant agrees that upon registration, payment for the seminar becomes due subject to a 14 calendar day cancellation policy. Registrant agrees that once beyond the 14 calendar day cancellation period, or within 14 calendar days of the course start date, payment is due irrespective of actual attendance or whether payment has been made. Substitutions are permitted. The policy has no exceptions.

Agreement *

I agree to the registration and cancellation policy.

Please make payment within 10 days. We accept checks only. Payment must be in the name:

Center for Police Leadership, 13 Abbottsford Drive, Suite 103, Pinehurst, NC 28374

DO NOT MAKE CHECK PAYABLE TO THE SPONSORING AGENCY

* Required to submit this form

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