Law Enforcement STAR Application Form

*Payment Method:

*Law Enforcement Member or Organization, please provide your agencies/organization name, supervisors name and phone number:

*Full Name:

*Date of Birth:

*Last Four Digits of Social Security Number:

*Does the Attendee have Medical Insurance?

*Email:

*Phone:

*Address:

*City:

*State:

*Zip:

*Name of Class:

*Total Amount:

Notes: