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Domestic Terrorism
Thursday, March 5 - Friday, March 6, 2020
Registration 0830 Class Starts 0900 - 1600
Location: Westchester County Police Academy
Directions: 2 Dana Road, Valhalla, NY 10595

Cost: Free
Law Enforcement & Military Personnel Only
Questions? - Email info@nctccounterdrug.org

Registration for this training DOES NOT confirm your enrollment in the course. 
 NCTC makes its student selections 45-60 days before the start of the course,
at which time you will receive an email if your registration is accepted.

Participants in this course learn about domestic terrorist groups, how to recognize indicators relating to domestic terrorism, and funding through narco-terrorism. Students explore law enforcement’s roles and responsibilities in combating domestic terrorism. Officer safety issues relating to domestic terrorism are also covered.

STUDENT CONTACT INFORMATION
*REQUIRED
First Name:*

Last Name:*

Position/Title/Rank:*

Are you currently a member of the US Armed Forces
(Active, Reserve, Guard, or Auxiliary)?*
Yes  No
Phone Work: (include area code)*

Cell Phone: (include area code)*
Required for urgent notifications

Email Address:*
Please Re-Type Your Email Address:*

AGENCY / ORGANIZATION 
Agency/Organization Name:*

Agency Type:*

Agency City:*

Agency State:*

Agency Zip code:*

SUPERVISOR/TRAINING MANAGER
Full Name*

Phone Work:* (include area code)

E-mail:*


EMERGENCY CONTACT INFORMATION
Person to be notified in case of an emergency
Emergency Contact Name: *

Relationship: *

Phone Number: *

Address: (City, State, Zip) *


I AGREE TO THE FOLLOWING STATEMENT OF UNDERSTANDING

1.  PURPOSE:   This form will be signed by employees of agencies who are participating in programs or courses at the Northeast Counterdrug Training Center (NCTC).

2. PRIVACY ACT STATEMENT:  Personal data is solicited under authority of 10 USC 3012 and AR 27-40.  The information is used to determine eligibility for voluntary participation in activities of the Northeast Counterdrug Training Center.  Disclosure of requested information is voluntary, but failure to disclose all or any part of it may result in denial of permission to participate in such activities for [EventBuilder.EventTitle] on [EventBuilder.StartDate] at [EventBuilder.Location].

3.  DECLARATION:  I desire to participate at my own risk in the activity described above.  I represent that I will take all safety precautions necessary thereto, assuming sole and full personal responsibility for ensuring that all safety requirements are met to my personal satisfaction prior to my active participation in such activity.  I state that I am in good health, physically fit to engage in this activity, and have no known medical condition that could jeopardize my safety during such participation or be aggravated by such participation.  I understand that the United States, the Commonwealth of PA, the Northeast Counterdrug Training Center, their officers and employees, will not be liable for personal injury, illness, death, and property damage, costs, charges, claims, demands and liabilities of whatever kind, name or nature in any manner arising out of or in connection with my participation in the indicated activity.  This is not a waiver of any workers’ compensation coverage, medical benefits or treatment, which I am entitled to receive as an employee of my agency or other applicable medical coverage, nor does this statement subject any government party (U.S. Government, Commonwealth of Pennsylvania, NCTC, employees, officers, successors and assigns) to any liability not expressly authorized by law.  I understand and agree that I may be held personally liable for any damage or loss to the United States Government or the Commonwealth of PA that is caused by my negligence or misconduct, while participating in this activity.  I further understand that any and all buildings at Fort Indiantown Gap may contain lead paint and/or asbestos and willfully accept any responsibility or possible danger associated with those elements.