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2. First Name
3. Last Name
5. Address
7. State
8. Zip Code
9. City
11. Phone Number
12. Email Address
14. OPOTA Certified

    1. Yes
    2. No
15. Are you currently employed in law enforcement?

    1. Yes
    2. No
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17. 1. Receive an email copy of this form.
18. Email address

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19. Submit

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