L.E.A.D. Instructor Certification One Week Course

Name: L.E.A.D. Instructor Certification One Week Course
Start: 2018-09-26T08:00:00-04:00
End: 2018-10-02T16:00:00-04:00
Location: Monmouth County Police Academy

About the Training

Five Day Instructor Curricula Training

Sept 26, 27, 27 Oct 1, 2

Training Information

Training Selection
Venue
Event Start Date
Event End Date
Are you from a law enforcement agency located in New Jersey?*
Which NJ County are you from?
NJ Grant County Number of Attendees (1 Day)
Number of Attendees (1 Day In Person)
Our agency/organization is new to L.E.A.D. and we have never had an officer trained in any of your programs*

Person Registering Attendees

Person Registering Attendee's Rank/Title*
Person Registering Attendee’s First Name*
Person Registering Attendee’s Last Name*
Person Registering Attendees Email*
Department/Agency Name*
Deparment/Agency Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Office Phone*

Attendee #1’s Information
Attendee #1’s Rank/Title*
Attendee #1’s Name*
First Middle Last
Attendee #1’s Cell Phone*
Email*
Attendee #1's Curriculum Grade Teaching*
Attendee #1’s Name of Prior Program
Attendee #1’s Year of Other Program Training
Attendee #1 has previously been trained by L.E.A.D.*
Attendee #2’s Information
Attendee #2’s Rank/Title*
Attendee #2’s Name*
First Middle Last
Attendee #2’s Cell Phone*
Attendee #2’s Email*
Attendee #2's Curriculum Grade Teaching*
Attendee #2’s Name of Prior Program
Attendee #2’s Year of Other Program Training
Attendee #2 has previously been trained by L.E.A.D.*
Attendee #3’s Information
Attendee #3’s Rank/Title*
Attendee #3’s Name*
First Middle Last
Attendee 3 Cell Phone*
Attendee #3’s Email*
Attendee #3's Curriculum Grade Teaching*
Attendee #3’s Name of Prior Program
Attendee #3’s Year of Other Program Training
Attendee #3 has previously been trained by L.E.A.D.*
Attendee #4’s Information
Attendee #4’s Rank/Title*
Attendee #4’s Name*
First Middle Last
Attendee #4’s Cell Phone*
Attendee #4’s Email*
Attendee #4's Curriculum Grade Teaching*
Attendee #4’s Name of Prior Program
Attendee #4’s Year of Other Program Training
Attendee #4 has previously been trained by L.E.A.D.*
Attendee #5’s Information
Attendee #5’s Rank/Title*
Attendee #5’s Name*
First Middle Last
Attendee #5’s Cell Phone*
Attendee #5’s Email*
Attendee #5's Curriculum Grade Teaching*
Attendee #5’s Name of Prior Program
Attendee #5’s Year of Other Program Training
Attendee #5 has previously been trained by L.E.A.D.*
Attendee #6’s Information
Attendee #6’s Rank/Title*
Attendee #6’s Name*
First Middle Last
Attendee #6’s Cell Phone*
Attendee #6’s Email*
Attendee #6's Curriculum Grade Teaching*
Attendee #6’s Name of Prior Program
Attendee #6’s Year of Prior Program Training
Attendee #6 has previously been trained by L.E.A.D.*
Attendee #7’s Information
Attendee #7’s Rank/Title*
Attendee #7’s Name*
First Middle Last
Attendee #7’s Cell Phone*
Attendee #7’s Email*
Attendee #1's Curriculum Grade Teaching*
Attendee #7’s Name of Prior Program
Attendee #7’s Year of Other Program Training
Attendee #8 has previously been trained by L.E.A.D.*
Attendee #8’s Information
Attendee #8’s Rank/Title*
Attendee #8’s Name*
First Middle Last
Attendee #8’s Cell Phone*
Attendee #8’s Email*
Attendee #8's Curriculum Grade Teaching*
Attendee #8’s Name of Prior Program
Attendee #8’s Year of Other Program Training
Attendee #8 has previously been trained by L.E.A.D.*
Attendee #9’s Information
Attendee #9’s Rank/Title*
Attendee #9’s Name*
First Middle Last
Attendee #9’s Cell Phone*
Attendee #9's Curriculum Grade Teaching*
Attendee #9’s Email*
Attendee #9’s Name of Prior Program
Attendee #9’s Year of Other Program Training
Attendee #9 has previously been trained by L.E.A.D.*
Attendee #10’s Information
Attendee #10’s Rank/Title*
Attendee #10’s Name*
First Middle Last
Attendee #10’s Cell Phone*
Attendee #10’s Email*
Attendee #10's Curriculum Grade Teaching*
Attendee #10’s Name of Prior Program
Attendee #10’s Year of Other Program Training
Attendee #10 has previously been trained by L.E.A.D.*

Payment Information
Coupon Code
Total
Total
$0.00
Payment Method
Credit Card*
Card Details
Cardholder Name
Agency*
Authorized Personnel*

Rank/Title
First Name*

First
Last Name*

Last
E-mail Address*
Billing Adress is the same as Department/Agency Mailing Address*
- Yes
- No
Billing Address*
Street Address Address Line 2 City State ZIP Code
Comments
Certification of Accuracy*
I certify the information entered is correct

Name
This field is for validation purposes and should be left unchanged.

L.E.A.D. Instructor Certification One Week Course

Attendee #1’s Information

Attendee #2’s Information

Attendee #3’s Information

Attendee #4’s Information

Attendee #5’s Information

Attendee #6’s Information

Attendee #7’s Information

Attendee #8’s Information

Attendee #9’s Information

Attendee #10’s Information

Payment Information