Imperial HIDTA - LECC


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CONTACT INFORMATION
(for registration purposes only)
First Name  *

Last Name *

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Are you sworn law enforcement? *
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Are you a HIDTA Member?
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Mobile Phone: (###-###-####)

E-mail:  *

 

AGENCY / ORGANIZATION
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Federal State Local  MiltaryOther
Agency Address: *

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Agency City: *

Agency State:*
  Agency Zip code:*

SUPERVISOR INFORMATION

For Law Enforcement Status Verification
Supervisor Full Name

Supervisor Phone Work: (###-###-#### - ext)

Supervisor E-mail:

All registration information is considered strictly confidential and will not be shared.