APPLICATION
CHEMICAL WEAPONS INSTRUCTOR COURSE
September 18-19, 2017
BATON ROUGE, LOUISIANA
NAME:____________________________________________________________________________

DEPARTMENT: _____________________________________________________________________

ADDRESS:_________________________________________________________________________

CITY, STATE, ZIP: ____________________________________________________________________

PHONE:___________________________________ FAX:____________________________________

ADDITIONAL NAMES:_________________________________________________________________
___________________________________________________________________________________

___ Class fee of $395.00 per person

___ Register the above name(s) at $395.00 each on department P.O.#____________________________

Police Officers who nee
d to be recertified must go through the 2 day class.
There is a new lesson plan with new material and new Instructors.



Please make check payable to: Baton Rouge Police Supplies, Inc.
                                  9530 Cortana Place
                                  Baton Rouge, LA  70815

Deadline for Registration is August 31, 2017

___________________________________________       ____________________________________
Authorized Signature                                                                           Date
Baton Rouge Police Supplies, Inc.
9530 Cortana Place
Baton Rouge, LA  70815
225-924-4948
Fax 225-924-4947