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Midwest Counterdrug Training Center
STUDENT CONTACT INFORMATION*All Fields Are Required First Name:* Last Name:* Position/Title/Rank:*Phone Work: (include area code)* Cell Phone: (include area code)* Email Address:*NOTE: .mil addresses are currently unable to receive confirmation emails or attachments from MCTC
AGENCY / ORGANIZATION Agency/Organization Name:* Agency Type:*PLEASE SELECTMilitaryFederal Law EnforcementState Law EnforcementLocal Law EnforcementTribal Law EnforcementCommunity Based OrganizationOther Agency City:*
ADDITIONAL QUESTIONSAre you currently a member of the US Armed Forces (Active, Reserve, Guard, or Auxiliary)?* PLEASE SELECT Yes No Is your agency/organization a HIDTA participant?*PLEASE SELECTNo HIDTAUnsure/UnknownAppalachiaArizonaAtlanta/CarolinasCentral FloridaCentral Valley CaliforniaChicagoGulf CoastHawaiiHoustonLake CountyLos AngelesMichiganMidwestNevadaNew EnglandNew MexicoNew York/New JerseyNorth FloridaNorthern CaliforniaNorthwestOhioOregon/IdahoPhiladelphia/CamdenPuerto Rico/US V.I.Rocky MountainSan Diego-Imperial ValleSouth FloridaSouth TexasTexomaWashington/BaltimoreWest TexasWisconsin
NO-COST LODGING*Will you require lodging?* PLEASE SELECT Yes No Will you require lodging the night prior to the class?* PLEASE SELECT Yes No