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CLES Security Form
Please fill in the below information only for those family members attending the conference.
REGISTRANT
First Name (Registrant):
  *
Last Name (Registrant):
  *
Rank (Registrant):
Marital Status (Registrant):
Married
Single
Widowed
Divorced
  *
Agency (Registrant):
  *
Agency Phone (Registrant):
  *
Years in LE (Registrant):
  *
LE Status (Registrant):
Certified
Civilian
Corrections
  *
SPOUSE
First Name (Spouse):
Last Name (Spouse):
Agency (Spouse):
Agency Phone (Spouse):
Years in LE (Spouse):
LE Status (Spouse):
Certified
Civilian
Corrections
CHILDREN
(1) Name, Sex, Age:
(2) Name, Sex, Age:
(3) Name, Sex, Age:
(4) Name, Sex, Age:
(5) Name, Sex, Age:
(6) Name, Sex, Age:

CONTACT INFO
Address:
  *
City:
  *
State:
  *
Zip:
  *
Home Phone:
  *
Cell Phone:
  *
E-mail:
  *
Conference You Are Registering For:
Ridgecrest Fall 2009
Ridgecrest Spring 2010
Ridgecrest Fall 2010
  *
After your eligibility is confirmed, you will be contacted by a CLEF Team member via email with a confirmation number and contact instructions for making your conference and lodging reservations.  Please be sure your email and contact phone are correct then submit your registration/security form.
* Required field