Attendee Registration Form
$399.00 per person, payable by check or credit/debit card
Rank/Salutation (please select your rank/salutation)
*
Please Select
Assistant Attorney General
Assistant Chief
Assistant Commissioner
Assistant Director
Assistant District Attorney
Assistant Sheriff
Assistant Solicitor General
Assistant State's Attorney
Assistant Superintendent
Attorney
Attorney General
Captain
Chaplain
Chief
Chief Deputy
Chief Investigator
Colonel
Commander
Commissioner
Commonwealth Attorney
Coordinator
Corporal
Deputy
Deputy Chief
Deputy Commissioner
Deputy Inspector
Deputy Marshal
Deputy Superintendent
Detective
Director
District Attorney
Dr.
Inspector
Liaison
Lieutenant
Lieutenant Colonel
Major
Marshal
Mr.
Ms.
Officer
Professor
Ranger
Reverend
Sergeant
Sheriff
Solicitor General
Special Agent
Specialist
State's Attorney
Superintendent
Trooper
Undersheriff
First Name (no titles or abbreviations please)
*
Last Name (no titles or abbreviations please)
*
Position/Job Title (no abbreviations please)
*
Full Agency/Organization Name (no abbreviations please)
*
Type of Agency:
*
Local
State
Federal
Tribal
Campus
Special Jurisdiction
Non-Applicable
Are you a sworn or civilian (non-sworn) law enforcement professional?
*
Sworn
Civilian
Neither
Email
*
example@example.com
Confirm Email
*
example@example.com
Office Phone Number
*
Cell Phone Number
Address Line 1
*
Address Line 2 (suite, floor, building number, etc.)
City
*
State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
District of Columbia
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Northern Mariana
Puerto Rico
U.S. Virgin Islands
Zip Code
*
How many years have you been in the law enforcement profession?
*
Less than 1 year
1-5 years
6-10 years
More than 10 years
Non-Applicable
Do you require approval from agency/organization leadership to attend in the conference?
*
Yes
No
T- Shirt Size (Unisex)
*
Small
Medium
Large
XL
XXL
3XL
Do you agree to participate in all official conference activities?
Yes
No
Payment Method
*
Pay Registration by Credit or Debit Card
Pay Registration Fee by Check
Registration and Supplemental Fees
*
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Registration Fee
$
399.00
Quantity
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Payment Information - Registration
If paying by check, please make the $399 registration fee check payable to MovementForward, Inc. Mail Checks to: MovementForward, Inc. 2987 Clairmont Road, NE - Suite 230 Atlanta, Georgia 30329
Payment Information - Supplemental
If paying by check, please make the $99 supplemental fee check payable to MovementForward, Inc. Mail Checks to: MovementForward, Inc. 2987 Clairmont Road, NE - Suite 230 Atlanta, Georgia 30329
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