Field Training Officer Master Trainer
Registration Form


$650.00 Per Person
Make checks payable to APTAC
Payment must be received 2 weeks prior to class start date


     Location:                 St. Louis County & Municipal Police Academy
1266 Sutter Avenue
              St. Louis, Missouri  63133-1934

              Contact – Becky Murphy – 314-889-8608 – bamurphy@stlouisco.com
              www.stlcmpa.org

Date:                March 1 Thru March 12, 2010

Student Information

1. NAME: _______________________________  RANK: ______  SSN: _____-____-______


2. NAME: _______________________________  RANK: ______  SSN: _____-____-______


3 NAME: _______________________________  RANK: ______  SSN: _____-____-______


Authorized Training Registrar: __________________________________________
(must sign here)

Print or type Registrar's Name: __________________________________________

Title: __________________________________________

Department Information

Department:         ____________________________________________________

Address:                ____________________________________________________

                   ____________________________________________________

Phone #:                ____________________________________________________


FAX #:                ____________________________________________________