Police Executive Development (POLEX)

Communication Agreement:

Your Name *

Your Email Address *

By checking this box, I agree to allow Penn State to communicate with all of my organization's registered attendees by email, as well as release all attendance and completion records to our employer, if requested. I have read JASI’s cancellation policy. * I agree

Police Department / Organization:

Full Organization Name *

Phone *

County *

Website *

Training Coordinator:

Who is the training coordinator for your police department or organization?

Training Coordinator First Name *

Training Coordinator Last Name *

Training Coordinator Email *

Training Coordinator Phone *

Billing Contact:

Payment instructions will be sent to this person's email address.

Billing Contact First Name *

Billing Contact Last Name *

Billing Contact Email *

Billing Contact Phone *

Billing Contact Address *

Billing Contact City *

Billing Contact State *

Billing Contact ZIP Code *

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