10th Annual Breachers Symposium • May 24-27, 2010 Tucson, AZ
The following was submitted to NTOA for registration
You must be sworn law enforcement or military
personnel to attend this symposium or you must be approved by
NTOA/TEES/REST/NSA.
Student First Name:
M.I.:
Last Name:
Rank:
Assignment:
Other:
Home Phone:
Home Address:
City:
State:
Zip:
Home (Primary) Email:
Send U.S. Mail to:
Agency Name:
Agency (Secondary) Email:
Agency Address:
City:
State:
Zip:
Agency Phone:
Agency Fax:
Payment must be properly listed to reserve your spot (no military
credit cards accepted). Symposium Cost: $250
Credit Card:
Credit Card #:
Expiration:
Credit Card Code:
(VISA & MasterCard: 3 digit number on
card back - American Express: 4 digit number on card front)
Name on Card:
Card Holder Phone:
Credit
Card Billing Address:
City:
State:
Zip:
Card
Holder Signature (type for
electronic signature):
CANCELLATION POLICY:
Student will receive full refund of fee if
cancelled in writing 30+ days prior to course start.
NTOA will charge $100 cancellation fee if written
notice is received less than 30 days prior to course
start. No written notice -- no refund. Qualified
substitutions are always acceptable. NTOA
reserves the right to cancel any course up to 30
days prior to course start. Please do not make any
non-refundable travel arrangements before this time.
STUDENT LIABILITY WAIVER: In consideration of my attendance and participation in this National Tactical Officers Association’s Training Course, I hereby, for myself, my heirs, executors, administrators and assignees, waive and release any and all rights and claims for damages I may have or may accrue against the National Tactical Officers Association, its officers or instructors, and co-host agency for any and all injuries which may be suffered by me as a result of my attendance and participation. I understand that by submitting this form electronically that I am not registered for the aforementioned course until I receive written confirmation from the National Tactical Officers Association.
Student's Signature (type for electronic signature):