KJA Basic Jail Academy
Dates of Class: June 1-5, 2009

Class Cost:
Class=$50 for non-members or $40 for members to be paid to the KJA PO Box 3536, Lawrence, KS 66046-0536

Personal Information:
Last Name:
First Name:
Contact Number:
Contact Number:
Are You Currently A KJA Member? (Y/N):

Room and Meals:
If staying in the Dodge City Community College Dorms, and/or eating meals there, your Agency will be billed accordingly by the Dodge City Community College.
Rooms are available in the DCCC dorms for this training.
Will you be needing a room? (Y/N):
If you answered Yes to the above question your meals are provided with the cost of the room.

If not staying at the dorms, will you need meals provided?
All meals: Just lunches:

Sex (for room assignment only) M/F:

Agency Information:
Agency:
Mailing Address:
City:
State:
Zip:
Jail Administrator/Supervisor Name:
Jail Administrator/Supervisor Contact #:
Jail Administrator/Supervisor Email Address: