Please Print the Application below and mail or fax it to us!

Aerko International

3410 NE 5th Avenue

Oakland Park, Fl 33334

Fax: (954)-565-8499

APPLICATION FOR ADMISSION

COURSE TITLE:  CERTIFIED CHEMICAL WEAPONS INSTRUCTOR

CHECK ONE:  POLICE __________  CORRECTIONS __________

NAME:  ______________________________ RANK:  ___________________________

DEPARTMENT:  __________________________________________________________

PREFERRED MAILING ADDRESS

            STREET / BOX  ____________________________________________________

            CITY  _______________________________ STATE  __________ ZIP  _____________

            PHONE NUMBER (______)-_________-_______________

COURSE DATES:  _______________________________________

  AUTHORIZED SIGNATURE  _________________________________

DATE:  _________________________

CHECK ENCLOSED ______________     DEPARTMENT P.O. __________________