CIT Crisis Intervention Training  - February 1st, 2nd, 3rd, 4th & 5th, 2021

First Name: *   Last Name:     *    DOB:     MM/DD/YYYY

       PID #:     (if your PID is unknown, or you never had one - just leave this entry blank)

      Agency:

   Address: 

        City:     State:       Zip Code: 
 
        Work phone: 

                   Cell:                *  (In case the instructor needs to contact you during the class week)

                E-Mail: *


PLEASE CHECK ALL THAT APPLY:

       Student is a Texas Peace Officer, Licensed

       Student is a Licensed Telecommunicator

       Student is elected, not licensed

       Student is a County Jailer

       Student is a civilian and needs TCOLE training credit

       Student is a civilian or does not need TCOLE Training credit
    
       Yes, I have a special needs request, Dietary / Accessibility, etc.
               Please explain:

      My agency/company requires an invoice/billing before they will prepare a payment

     I am bringing a check ($250) with me

     I will be paying by credit or debit card ($250 + $7.78 credit card fee) when I arrive for the training

     I will be paying online, a $7.78 credit card fee will be added, Total $257.78     

     I understand that I should bring a laptop to use during class
                 (The student manual will be available for Download at the beginning of the first class.)

PLEASE SUBMIT THE FILLED-IN REGISTRATION FORM ABOVE,

If your registration form was processed successfully you will be returned to this page.

STOP - Do not continue until you send the registration Form

If you have completed and submitted your registration form above  and
wish to pay online now (There is a $7.78 credit card processing fee)
you may click this Pay Now button:  

If you have completed the "Pay Now" button process and are returned to this page,
a paid Invoice/Receipt will be given to the student when they arrive to begin class.

Any questions or concerns please call our AACPA Treasurer, Don Carr 210-381-0250 (24/7).