Training Schedule - Registration Form

Law Enforcement Training Courses and Schedule

Seminar Information

You are registering for:
Seminar Title:
Seminar ID#:
Dates 9/20/2010 through 9/22/2010 Instructor Gregory Goltz Location North Cornwall Township Bldg 320 S 18th Street Lebanon, PA 17042 Hotel Hampton Inn 2764 Lebanon Rd Manheim, PA 17545 717-665-6600 $99.00 single or double Identify with PATC to receive discounted rate Registration Fee $295.00 Includes handouts and training manual, and a Certificate of Completion.

Please fill in the fields below and click the Submit button

You will receive email confirmation of your registration within 1 Business Day - including Seminar Fee, Location, and Hotel information.

Attendee Information

Names of Attendees:

First Last Email

Please include all of the names of the people attending the conference. Place each name, without titles or rank, on a separate line. Thank you.

This:
John Smith
Jane Doe Not this:
Sgt. John Smith, Ofc. Jane Doe

At least one person's First Name Required

At least one person's Last Name Required

Agency Information

Agency Name:

Please do not use punctuation.

Required

Invoice to Attention:

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Address:

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City:

State:

Zip:

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Contact Email: (Enter Twice for Verification)

Email Address

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Email Again

Required to Match

Phone:

Required. You may use spaces or hyphens if you wish.

Fax:

Payment Information

Pre-Payment is NOT REQUIRED to register. Upon receiving your registration an invoice is sent to the Agency listed above.
Method of Payment:	Required

Card Number		Exp Date

Name on Card		Secure Code

You will receive email confirmation of your registration Including Seminar Fee, Location, and Hotel information.

Submit your registration now!

Thank you for registering for a PATC Seminar!

If you have any questions please call 800-365-0119

Public Agency Training Council - 5235 Decatur Blvd - Indianapolis, IN 46241 - 800.365.0119