You are signing up to register for the Decon Training for Today’s Real World Responses course through Chautauqua County Emergency Services. Please complete all of the following information.

YOU MUST BRING A SIGNED CHIEF'S AUTHORIZATION LETTER TO THE FIRST CLASS.

Question Title

* 1. What is YOUR name?

Question Title

* 2. The applicant understands that a "Chief's Authorization Letter" must be presented at the first class?

Question Title

* 3. Applicant's Last Name:

Question Title

* 4. Applicant's First Name:

Question Title

* 5. Best Phone Number to reach Applicant:

Question Title

* 6. Applicant's Email address:

Question Title

* 7. Applicant's Fire Department:
(LEO - choose 'Law Enforcement' and specify Department in "other")

Question Title

* 8. Is the applicant a Junior member, Venturer or Explorer of the Department:

Question Title

* 9. Applicant's Chief's Name:

T