Impaired Driving Conference Registration

For the questions below, please provide numbers for calendar year 2023.

Event:
First Name:
Last Name:
Organization:
Address:
City:
State:
Zip Code:
County:
Phone:
Email Address:
Re-type Email Address:
Send A Copy Of This Completed Form To Email Address:
Will you attend the Mixer?	Yes No
Are you Law Enforcement?	Yes No
Are you an attorney?	Yes No
Number of DUI arrests if you are an officer:
Number of DUI arrests in your agency:
Prosecutors: Number of DUI cases that were either plead, prosecuted or took a diversion: