FACA REGISTRATION



FACA REGISTRATION

CHEMICAL IMMOBILIZATION COURSE

FACA CERITIFIED

POLK COUNTY SHERIFF’S OFFICE

AGRICULTURAL CRIMES UNIT

4200 BEN DURRANCE ROAD

BARTOW, FLORIDA 33830

SEPTEMBER 6TH & 7TH 2017

$95.00 per Student for FACA Member Agencies

$150.00 for non FACA Members

Please complete the following, (print or type please):

Name: ______________________________________________

Position/Title: _____________________________________________

Agency/Dept/Business: _______________________________________

Business Address: _________________________________________________

_________________________________________________

Work Phone: ___________________ Fax Number: ____________________

Cell Phone: _____________________ Direct Connect ___________________

E-Mail: _________________________________________________________

MAKE CHECKS PAYABLE TO FACA

BRING FORM AND OR REGISTRATION FEES TO

4200 BEN DURRANCE RD.

BARTOW, FL 33830

Or can be mailed to the above address attn:

Det. Mike Burdette

INSTRUCTORS

DETECTIVE MIKE BURDETTE

M. GENE SMITH

POLK COUNTY SHERIFF’S OFFICE

(Student may bring form and check with them to first day of class)

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