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: May 15 Thru May 20, 2011 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 #: ____________________________________________________ |