Maryland Police and Correctional Training Commissions Registration Form
PROGRAM NAME: “Current Trends VI: “What’s Happening Now……”
LOCATION: Holiday Inn Express, 1020 Kent Narrows Road
Grasonville, MD 21638 (Queen Anne’s County)
DATE: March 30 and 31, 2011 8:00 a.m. – 4:00 p.m.
REGISTRATION INFORMATION: PLEASE PRINT OR TYPE ALL INFORMATION
AGENCY NAME: ____________________________________________________________________
AGENCY ADDRESS: _________________________________________________________________
CITY/STATE: ___________________________________________ ZIP: ________________________
AGENCY CONTACT: ____________________________________ DATE: ______________________
TELEPHONE: ______________________________ FAX: ______________________________
The following individual from my agency is being nominated to attend the above referenced training.
NAME (print) RANK/POSITION
I certify that the above information is true and correct.
___________________________ ______________________________ ____________
Signature of Approving Supervisor Please Print/Type Name Date
This training is free of charge. Seating is limited to 65. In order to accommodate as many departments as possible, MCCPI reserves the right to limit the number of personnel attending from any given department.
MAIL ORIGINAL OR FAX TO: Maryland Police & Correctional Training Commissions
Attn: Patricia Sill, MCCPI
6852 4th Street
Sykesville, MD 21784
PLEASE REGISTER BY MARCH 14, 2011
Revised July 2008