1 Community Registration Form 2025

Name*

First NameLast Name

Agency Name*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Preferred Course Location*

Livingston Parish Sheriff's Office

Select a Course Date - East Baton Rouge Sheriff's Department

Select a Course Date - St. Bernard Sheriff's Department

Select a Course Date - Livingston Parish Sheriff's Office

Select a Course Date - Zachary Police Department

Select a Course Date - Lafayette Parish Sheriff's Office

Select a Course Date - Livingston Parish Sheriff's Office

Number of Attendees

Please provide name and contact info for each of the attendees.

Payment Information*

3 Day Injury Prevention Training Course

$950.00 Quantity

Movement Screens

$200.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country