Texas City Law Enforcement Training Academy #167209

HEMPSTEAD POLICE DEPARTMENT TRAINING DIVISION #473202

IN-SERVICE COURSE PRE-REGISTRATION FORM

*Name / Title / Rank
*TCLEOSE PID # / Date of Birth:
*Name of Agency / *Agency Phone
Mailing Address: / Business
Personal
City: / St: / Zip:
Email: / Alt Ph: / Home
Cell
METHOD of PAYMENT: Cash Check Invoice Agency (Purchase Orders accepted)
If invoicing agency, please provide the correct information (*) above.
Please make all checks payable to the City of Hempstead Police Department
PRE-PAYMENT IS NOT REQUIRED TO REGISTER
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* Requested Course(s) / Date / Time
1.
2.
3.

Fields marked with an asterisk (*) must be completed. All other fields are optional.

The preferred method of contact is email. Please list the appropriate email address.

For additional information on upcoming classes visit our website at www.hempsteadpdtx.com and click on the icon marked, “Training Corner”.

Ver 1: June 2012