Community Advisory Forum Registration - Arkansas Criminal Justice Institute Arkansas Criminal Justice Institute

Course Name *

Course Date *

Rank/Title/Position *

First Name *

Middle Initial (if you have no middle initial, enter NMI) *

Last Name *

Nickname/Preferred Name

Email *

Would you like training schedule notifications emails sent to you?

CLEST-ID Number (Required for Arkansas Commission on Law Enforcement Standards & Training (CLEST) reporting if you are Arkansas LE.)

Cell Phone Number *

Alternate/Evening Phone Number

Address *

Street Address Address Line 2 City State ZIP Code

County *

Do you need a hotel room?

Do you live more than 50 miles from Jonesboro?

Employer *

Employer Phone/Extension

Employer Fax

Position Type (Select all that apply) *

If you selected other, What is your position?

How did you hear about this class?

If you selected "Other" above, how did you hear about this class?

Gender *

Race *

Ethnicity *

Name

This field is for validation purposes and should be left unchanged.