First Name (*)

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Last Name (*)

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Rank

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Agency Phone

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Email

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Employment Status
Full TimePart TimeReserveRetired
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Agency Address

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State

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Home Address

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Home State

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Home Phone

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Team Status
Full TimePart Time
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Number of Team Members

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Area Served

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Monthly Training Hours

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Submit to NTOA

Middle Initial

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NTOA Member Number (*)

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Agency Name (*)

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Agency Fax

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Send Mail To
HomeAgency
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Type Membership (*)
IndividualTeam (point of contact)
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City

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Zip

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Home City

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Home Zip

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Assignment
SWATCNTPatrolTEMSEODother
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Multi Jurisdictional Team
YesNo
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Population Served

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Total Sworn Officers

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