Registration Application Please complete the following form. You MUST include PID#. Name * First Name Last Name Email Gender Male Female Ethnic Origin Date of Birth MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Social Security Number Driver's License Number Include state and expiration Employer PID# Work Phone (###) ### #### Peace Officer & Reserves Licensed Telecommunicators Elected Official County & Contract Jailers Civilians not licensed by TCOLE Course Title, Number & Credit Hours Course Beginning Date MM DD YYYY Course Tuition (if applicable) $ Date Paid MM DD YYYY Thank you!
