There Is No Registration Fee for This Course
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A-RIDE Registration Form (Please print clearly. This information will be used for your certificate and official record.)
Contact Information Sam Name First Middle Last (Include Jr., Sr., etc.) Houston State TCLEOSE PID*______Date of Birth University Mailing Address Street or Box No. City State Zip
Work Phone______Fax Number
ARIDE Pager______Cellular Number Advanced Home Phone______Roadside Impaired Driving E-Mail Address Enforcement Course Peace Officer Status: ___ Full-Time ___Reserve ___Cadet ___Other (If you are a peace officer, check the appropriate box. This for your TCLEOSE Record)
Verification of SFST: Date(s) Attended: ______BEAUMONT ** Attach copy of Tcledd’s report showing 24 hr SFST course.**
January 31 – Agency/Company Information February 1, 2012 Agency/Company Name
Address Street or Box No. City State Zip
Job Title Course Information THERE IS NO REGISTRATION FEE FOR Course Title____A-RIDE______Credit Hours 16 THIS COURSE Starting Date January 31, 2012 Ending Date February 1, 2012 ______MUST BE SFST PROFICIENT TO ATTEND Course Location 700 North St. Beaumont______TX___ 77701 _ Site Address City State Zip
Facility Name _ Foundation for Southeast Texas ______
After completing registration, please e-mail to [email protected] or fax to 936.294.3263.
Signature ______Date Signed ___
A-RIDE Registration\ Student Information 08/07 A-RIDE Registration\ Student Information 08/07