BASSET Certified Alcohol Awareness Program

2. ELMHURST POLICE DEPARTMENT Specialized Training Course Registration
4. Course Title:
5. B.A.S.S.E.T. Certified Alcohol Awareness Program
7. Location:
8. See Available Dates for Location Information
10. Date:
11. Available Dates*
    -- Select One --November 16, 2021 - Police Training Room (125 E. First St.)
13. Time:
14. 5:00 p.m. to 9:00 p.m.
16. Training Fee:
17. $30.00 Payable to City of Elmhurst (check, money order or cash) at time of class unless other arrangements have been made.
19. Liquor Establishment Name*
21. Manager Responsible*
23. Registrant Last Name:*
24. Registrant First Name:*
25. Middle
27. Phone Number:*
28. Email Address:*
30. 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