Exit Program
Complete this Form prior to January 31, 2020

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Agency

Question Title

* 4. Email Address

Question Title

* 5. Phone Number

Question Title

* 6. Rank

Question Title

* 7. If "Other Rank" was selected, please tell us your rank.

Question Title

* 8. Did you attend the 2019 Highway Safety Training for Patrol Supervisor's in Ocean City Maryland?

Question Title

* 9. Did you attend the 2018 Highway Safety Training for Patrol Supervisor's conference?

Question Title

* 10. Describe your Supervisory Duties / Job Description.

Question Title

* 11. The Maryland Highway Safety Office will be making reservations for those who are accepted to attend this training.  Those accepted will receive a confirmation email prior to the training, therefore there is no need to contact the hotel requesting or confirming reservations.  Thanks!

How many nights, if selected, would you be planning on staying at the Grand Hotel 2100 Baltimore Avenue in Ocean City, Maryland?

Question Title

* 12. Approved to attend this training by:

Question Title

* 13. Name of Authorizing Official approving this training.

Question Title

* 14. Authorizing Official's email

( Privacy & Cookie Notice

T