STUDENT INFORMATION * required
First Name *

Last Name *

Position/Title/Rank *

Work Related Email Address: *

Retype Your E-mail Address: *


Sworn Law Enforcement Officer *
Yes  No

Non-Sworn Crime / Intelligence Analyst *
Yes  No
If other, please provide details below.

AGENCY / ORGANIZATION
Agency/Organization Name: 

City: *

County: *


Indicate your agency type *
Federal State Local
Military Other

HIDTA TASK FORCE MEMBER
Are you a task force member? 
Yes No

PROFESSIONAL LICENSE NUMBER
P.O.S.T. ID / EMT / EMTP / RN 

 Credentials required at check in for in person events