NTOA || National Tactical Officers Association

10th Annual Breachers Symposium • May 24-27, 2010 • Tucson, AZ

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:

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Other:

Home Phone:

Home Address:

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Home (Primary) Email:

Send U.S. Mail to:

Agency Name:

Agency (Secondary) Email:

Agency Address:

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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:

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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):

Date: