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: ______________________________

 

E-MAIL: ____________________________________________________

 

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

                                                                      PHONE:  410-875-3425

                                                                      FAX:       410-875-3420

                                                 PLEASE REGISTER BY MARCH 14, 2011                                                                                                 

 

Revised July 2008