BASIC INSTRUCTOR COURSE
        November 13, 14, 15, 16, 2018

NAME
    First: *   Last:      *  (Name to be printed on Graduation Certificate)  

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

    Birth Date:  *   Agency: 

   Address: 

        City:     State:        Zip Code+4: 
 
        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 reported.

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

      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 + $10 credit card fee) when I arrive for the training.

     I will be paying online, a $10.00 credit card fee will be added, Total $260.00.

     I understand that I should bring a laptop to use during class.
                 (the student manual and etc. will be provided from a USB flash drive)
    

PLEASE SUBMIT THE FILLED-IN REGISTRATION FORM ABOVE,

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

If you have completed and submitted your registration form above  and
wish to pay online now (There is a $10.00 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.

Please allow 48 hours for the student's name to appear on the online registered list.

Any questions or concerns please call our AACPA Treasurer Don Carr 210-659-2710 (24/7).