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Public Safety Citizens Academy Application
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Full legal name
*
Address
*
City
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State
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Zip Code
*
Personal phone
*
Work phone
*
Email
*
Men's t-shirt size
*
Birth date
*
Driver's license number
*
Date
*
Electronic Signature
By typing my name here and submitting this form, I certify that the information provided is true and correct to the best of my knowledge. I understand that my typed name constitutes my electronic signature and has the same force and effect as a handwritten signature.
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