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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