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FORMTEXT Work Phone://///wAAAAAUAAYAVABlAHgAdAAyADEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT Extension://///wAAAAAUAAYAVABlAHgAdAAyADIAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT Mail Address://///wAAAAAUAAYAVABlAHgAdAAyADMAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT City://///wAAAAAUAAYAVABlAHgAdAAyADQAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT State://///wAAAAAUAAYAVABlAHgAdAAyADUAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT Zip Code://///wAAAAAUAAYAVABlAHgAdAAyADYAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT Course SelectionAdvance/On SiteAdvance/On SiteNYS 8 Hr. Pre-Assignment/////2UAAAAUAAYAQwBoAGUAYwBrADMAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FORMCHECKBOX $90.00/$100NYS 16 Hr. OJT/////2UAAAAUAAYAQwBoAGUAYwBrADgAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FORMCHECKBOX $160.00/$190NYS 8 Hr. Unarmed In-Service/////2UAAAAUAAYAQwBoAGUAYwBrADQAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FORMCHECKBOX $90.00NYS 47 Hr. Firearms Certification/////2UAAAAUAAYAQwBoAGUAYwBrADkAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FORMCHECKBOX $500.00NYS 8 Hr. Firearms In-Service/////2UAAAAUAAYAQwBoAGUAYwBrADUAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FORMCHECKBOX $150.00/NYS Homeland Security Enhanced/////2UAAAAUAAcAQwBoAGUAYwBrADEAMAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMCHECKBOX $425.00/$475CPR, First Aid, AED/////2UAAAAUAAYAQwBoAGUAYwBrADYAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FORMCHECKBOX $80.00/$95Basic Loss Prevention Associate/////2UAAAAUAAcAQwBoAGUAYwBrADEAMQAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMCHECKBOX $500.00Less Then Lethal Defense Systems/////2UAAAAUAAYAQwBoAGUAYwBrADcAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FORMCHECKBOX $150.00Detention, Arrest and Handcuffing /////2UAAAAUAAcAQwBoAGUAYwBrADEAMgAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMCHECKBOX $150.00*Please note, prices quoted are for single attendees and not for group enrollment. Please Contact us for group rates. Course Location and Date(s)Course Location://///wAAAAAUAAYAVABlAHgAdAAyADcAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT Course Dates://///wAAAAAUAAYAVABlAHgAdAAyADgAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT *Please visit our website: www.peelersecurity.com for scheduled course dates. Business groups are scheduled through our office.Payment MethodPayPal Credit Card Invoice by E-mail/////2UAAAAUAAcAQwBoAGUAYwBrADEAMwAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMCHECKBOX Invoice will be e-mailed to the address provided for payment within 48 hrs. of receiptCertified Check or Money Order/////2UAAAAUAAcAQwBoAGUAYwBrADEANAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMCHECKBOX Please enclose payment with enrollment application. Subtotal of Enrollment://///wAAAAAUAAYAVABlAHgAdAAyADkAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT 8% Sales must be added to all courses within New York State.Total Enrollment://///wAAAAAUAAYAVABlAHgAdAAzADAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT Certification and AuthorizationI certify the information provided is complete and truthful. I authorize NEA Training Center and The Peeler Group to verify the information provided and complete the necessary background check, which may include: criminal convictions, employment, licensing and reputation./////wAAAAAUAAYAVABlAHgAdAAzADEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT /////wAAAAAUAAYAVABlAHgAdAAzADIAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA=
FORMTEXT SignaturePrint NameDatePlease Fax or Mail Completed Enrollment Application with Payment