PUBLIC SAFETY ALLIANCE REGISTRATION FORM FOR:
DEALING DEATH: TRAFFICKING PRESCRIPTION DRUGS
Friday, April 26, 2019
0800 - 1700
Location: College of the Canyons, Canyon Country Campus
Directions: 17200 Sierra Highway, Room # 400, Santa Clarita, CA 91351

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Prerequisite: Students must be commissioned peace officers, reserve officers, or civilians acting under the umbrella of a law enforcement agency. Please contact Public Safety Alliance if you have questions.
 

Course Description:
This one-day course is tailor-made and provides officials with a unique understanding of the prescription drug epidemic plaguing our country. Students are provided with detailed quick tips that you can hear today, and use in the field, tomorrow. You will also develop an understanding of what to look for regarding "dirty doctors" and identifying how legitimate "patients" bend the system, and profit. Special modules include:
- Case Studies
- National Perspective
- Doctors Interviews

Who Should Attend: Patrol Officers, Probation, Detectives, Corrections, Agents, Medical Professionals

Dress Code: Uniform, business casual or the uniform of the day

Lodging and Meals: Students are responsible for their own hotel and meals. Local restaurants are listed on the flyer.

Contacts: If you are running late to the course or have other problems or questions regarding this course, please contact:

Program Manager, Nick Ramos at nickramos@trainPSA.org or (505) 573-9672.
Office, at info@trainPSA.org

APPLICANT INFORMATION *required 
Name will appear on certificate of completion
First Name: 
*

Last Name: *

Position/Title/Rank: *

Agency/Organization Name: *

State (2 characters e.g. TX): *

COMMENTS
Provide any specific information regarding registration
 

 

CONTACT INFORMATION
(for registration purposes only)
Phone Work: (include area code) *

Mobile Phone: (include area code)

E-mail: *

Alternate E-mail Address:

TRAINING COORDINATOR / SUPERVISOR
Full Name

Phone:  (e.g. ###-###-#### - ext) 

Training Coordinator Email Address: (if applicable)
(Will receive copy of confirmation)

 

Cost per person: $135

Method of Payment:
 Check / Pay at Door    Credit Card

Credit Card Information (all fields required)
Card Type

Cardholder's First Name

Cardholder's Last Name

Credit Card Number

Exp Date
(e.g.: 05/2020)
Security Code

 

Cardholder's Billing Street Address

Billing City

Billing State
(2-digit state code)
Billing Zip Code

Billing Country
(2-digit country code)

I AGREE TO THE FOLLOWING HOLD HARMLESS RELEASE AGREEMENT

I know that participation in some of the Public Safety Alliance projects can be potentially hazardous and I agree that my participation in this activity is entirely voluntary. I know I should not enter this activity unless I am medically able to participate and completing this PSA process attests that I am medically fit to participate.

  1. I fully recognize and appreciate the dangers and hazards inherent in the activity, which I have had a full opportunity to investigate through any questions I wished to ask of the responsible person(s). I agree to assume all the risks and responsibilities arising out of my participation in the activity and any other activities undertaken as an adjunct thereto.
  2. That in consideration of my participation in this activity, I hereby waive, release and forever discharge and agree to indemnify and hold harmless Public Safety Alliance and its trustees, officers, employees and agents, of and from any and all action, causes of action, suits, damages, claims and demands whatsoever, which the undersigned, may not have or may acquire arising from or in any way relating to the undersigned’s participation in the aforementioned event/activity.
  3. I recognize and understand that Public Safety Alliance does not provide any Accident or Medical Insurance.
  4. I have obtained the age of 18 and am legally competent to understand this document and agree to this release as my own free act.
  5. I hereby consent to any publicity, including the use of my name and likeness, in connection with my participation in this activity for Public Safety Alliance publications.
  6. I understand that Public Safety Alliance reserves the right to cancel or reschedule the course with no prior notification to students. Submitted registrations will be returned to the payee in full.
  7. I have read and understand the terms of this Release and agree to all terms and conditions.

Your email provider MAY block any sender who is not in your address book/contact list. In order to ensure you receive your certificates, course materiel and course notifications add these addresses BEFORE registering: NickRamos@trainPSA.org; Info@trainPSA.org; Training@trainPSA.org