Drug Abuse Recognition
Tuesday, October 24 - Thursday, October 26, 2017
8:00 AM - 5:00 PM
Location: Seal Beach
Directions: Seal Beach Police Department 911 Seal Beach Blvd. Seal Beach, CA 90740

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Class limited to 35

STUDENT INFORMATION * Required
First Name:
*
 
Last Name:
*
 
Middle Name:*
 
Position/Title/Rank:
*
 

YOUR AGENCY / ORGANIZATION NAME* 

Permanent Address: (no P.O. Boxes)*


City:*

State:*
Zip Code:*

CONTACT INFORMATION
Phone Work: (include area code)
*
 
Cell Phone: (include area code)
 

E-mail:
*
 
(Please Use Law Enforcement Agency Email Address)


IDENTIFYING INFORMATION *

 Sworn Law Enforcement Officer
Hispanic Non Hispanic / Latino
Post ID#:

Date of Birth (mm/dd/yy):*
 
(For College Credit)

Age:* 

Birth City:*
 

Birth State or Country:*
 
Last 4 digits of social security #  
Gender* Male Female

Previous Last Name (enter N/A if the same):*

 

HIGH SCHOOL LAST ATTENDED*
Name of High School*
 
County (if California)*
 
State or County (If NOT California)*
 

Year Graduated*
 


High School Graduation Status*
 

WHEN DID YOUR PRESENT STAY IN CALIFORNIA BEGIN?*
Approximate date you arrived in California (mm/dd/yy)*




PRICE:
$225

Members and Non-Members

 Law Enforcement Credentials Are Required at Registration

 

Cost per person: $225

Credit Card Information (all fields required)
Card Type

Cardholder's First Name

Cardholder's Last Name

Credit Card Number

Exp Date
(e.g.: 05/2018)
Security Code

 

Cardholder's Billing Street Address

Billing City

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

Billing Country
(2-digit country code)

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