Texas Narcotic Officers Association

East Region Training Registration Form

REGISTRATION FORM

(Please Print Clearly)

NAME OF MEMBER: _______________________________________ PID# ___________________

ADDRESS: _______________________________________________________________________

OFFICE PHONE NUMBER: __________________CELL PHONE NUMBER: __________________

EMAIL ADDRESS: _________________________________________________________________

AGENCY: ________________________________________ TITLE: __________________________

TRAINING LOCATION: ______________________________________________________________

COURSE TITLE: ___________________________________________________________________

DATE OF COURSE:________________________________________________________________

TOTAL COST: $___________

Method of payment:            Cash            Check            Purchase Order #

Credit cards not accepted

PLEASE SUBMIT TRAINING REGISTRATION FORM, ALONG WITH PAYMENT FOR TRAINING TO:

TNOA East Region Training

Attention: Dee Leal

10807 Jones Road PMB #173

Houston, Texas 77065

Cell: 832 605-3645

Email: deeleal@aol.com