Tri-State Regional Community Policing Institute     

COURSE REGISTRATION FORM

Directions:  Print this page, complete all information and fax to 513.771.0780 or mail to:

Tri-State RCPI
Attention: Registrar
3254 East Kemper Road
Cincinnati, OH 45241

COURSE TITLE______________________________   DATE_______________

NAME_______________________________________TITLE________________

AGENCY NAME____________________________________________________

ADDRESS__________________________________________________________

PHONE________________________          FAX____________________________

HOW DID YOU HEAR ABOUT US______________________________________

____________________________________________________________________

HAVE YOU ATTENDED COURSE BEFORE     YES_____NO_____

Circle One:       Police          Community          Probation/Parole         Courts             Corrections       Advocate       Other___________________

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