Region Training Request Form

Please complete and submit at least eight weeks prior to the proposed training date. All submissions are sent to Tariq Bruno, Membership Coordinator. For further questions, please reach out to Tariq at 916-520-2245 or at


    Name of Course:

    Instructor Name(s):

    Instructor Contact Information:

    Will training have an instructor fee?

    If so, how much?

    Date of Proposed Training:

    Member Fee:

    Non-Member Fee:

    Training Start Time:

    Training End Time:

    Is training POST certified?

    If so, what is the course control number?

    Location and Address of Training:

    Capacity of Venue:

    Number of anticipated participants:

    Can training be shared with other regions?

    Region leader presenting CPOA introduction
    (if different than person completing this form):




    Email Address:

    Description of Training (Or upload attachment below):

    Upload attachment:

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