BASSET Certified Alcohol Awareness Program

2. 

3. ELMHURST POLICE DEPARTMENT Specialized Training Course Registration

5. Course Title:

6. B.A.S.S.E.T. Certified Alcohol Awareness Program

8. Location:

9. City of Elmhurst Council Chambers, 209 N York St

11. Date:

12. Available Dates*
    -- Select One --January 24, 2019February 28, 2019April 4, 2019May 30, 2019June 27, 2019

14. Time:

15. 4:45 p.m. to 9:00 p.m.

17. Training Fee:

18. $30.00 Payable to City of Elmhurst at time of class unless other arrangements have been made.

20. Liquor Establishment Name*

22. Manager Responsible*

24. Registrant Last Name:*

25. Registrant First Name:*

26. Middle

28. Phone Number:*

29. Email Address:*

31. Position (Bartender, server, etc)*

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field