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Animal Cruelty Investigation
Training
Registration Form
Name:______________________________________________________
Organization and Title if
any:___________________________________
____________________________________________________________
Address:____________________________________________________
____________________________________________________________
Phone:(H)______________(W)______________(C)__________________
E Mail Address:_______________________________________________
Do you have any ACI or ACO experience? Yes
No
List experience and if you are currently an ACI or ACO:______________
_____________________________________________________________
_____________________________________________________________
List
any other experience that you feel would make you a good ACI.
______________________________________________________________
______________________________________________________________
______________________________________________________________
Will you be taking the class in hopes of being a Volunteer ACI with the
Blount County Humane Society? Yes No
Will you be taking the class as continuing education? Yes
No
Please tell us a little about yourself and why you are interested in ACI
Training:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
*Registration
Fee of $60 covers one day of class and lunch/refreshments.
You will also be provided a "Certificate of Completion" upon successful
completion of the class.
*$60
Dollar Registration Fee Enclosed ______
*Registration the day of the class is
permitted but will include a $20 late fee
for a total of $80.
*Lodging not
included in registration fee.
* Classes held
at Blount County Public Library located at:
508 North Cusick Street,
Maryville, TN, 37804
Make checks
payable to the Blount
County Humane Society
and mail to:
P.O.
Box 5446 Maryville, TN 37802
Please e mail
that you have sent in your registration so we can know as early as
possible who is attending class...Thank You!
humanesocietysteve@yahoo.com
For
more info please call:
Steven Phipps...865-742-3070
Please print this page/form and mail to address above.
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