REGISTRANT INFORMATION *required 
First Name: *

Last Name: *

Position/Title/Rank: *


AGENCY / ORGANIZATION
Agency/Organization Name: *

Agency Type *
Federal State Local MilitaryOther
Address: *

City: *

CONTACT INFORMATION
Phone Work: (include area code) *

Cell Phone: (include area code)

Email Address:
Must be a valid law enforcement / 
government email address: *

Please re-type your email address *

Create a Password: *
(8 characters - 1 special - 1 numeric


SUPERVISOR INFORMATION
An email will be sent to your supervisor for 
law enforcement status verification.
Please do not list yourself.
Full Name:*

Phone Work:* (###-###-####)

E-mail:* (Provide agency email address)