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2. Name*
   First, Middle, Last Name
3. Phone Number*
5. Date of Birth*
   Date of Birth
7. Address*
9. Date and Time Requested*
   Date and Time Requested

   Date and Time Requested
   Please indicate a date and time you would like to come to the Police Department for fingerprints and security awareness training.
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11. 1. Receive an email copy of this form.
12. Email address

    This field is not part of the form submission.

13. Submit

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