Application for Enrollment - Harley-Davidson

2014 Police Motorcycle Operator and Instructor Training
**Dates & Locations Are Subject to Change**
The Northwestern University Center for Public Safety and Harley-Davidson Motor Company will offer Police
Motorcycle Operator and Instructor Academies for the following dates and locations:
DATE LOCATION COURSE TUITION
January 6 – January 24, 2014 Gulfport, MS Instructor $1,795.00
January 13 – January 24, 2014 Gulfport, MS Operator $1,495.00
January 16, 2014 Gulfport, MS Instructor Re-Certification $150.00
March 3-March 21, 2014 Charlotte, NC Instructor $1,795.00
March 10 – March 21, 2014 Charlotte, NC Operator $1,495.00
March 13, 2014 Charlotte, NC Instructor Re-Certification $150.00
March 31– April 18, 2014 Knoxville, TN Instructor $1,795.00
April 7 – April 18, 2014 Knoxville, TN Operator $1,495.00
April 10, 2014 Knoxville, TN Instructor Re-Certification $150.00
April 21 – May 9, 2014 London, OH Instructor $1,795.00
April 28 – May 9, 2014 London, OH Operator $1,495.00
May 1, 2014 London, OH Instructor Re-Certification $150.00
May 12 – May 30, 2014 Kokomo, IN Instructor $1,795.00
May 19 – May 30, 2014 Kokomo, IN Operator $1,495.00
May 22, 2014 Kokomo, IN Instructor Re-Certification $150.00
June 9 – June 27, 2014 Tazewell County, IL Instructor $1,795.00
June 16 – June 27, 2014 Tazewell County, IL Operator $1,495.00
June 19, 2014 Tazewell County, IL Instructor Re-Certification $150.00
July 7 – July 25, 2014 Fort McCoy, WI Instructor $1,795.00
July 14 – July 25, 2014 Fort McCoy, WI Operator $1,495.00
July 17, 2014 Fort McCoy, WI Instructor Re-Certification $150.00
August 11 – August 29, 2014 Springfield, MO Instructor $1,795.00
August 18 – August 29, 2014 Springfield, MO Operator $1,495.00
August 21, 2014 Springfield, MO Instructor Re-Certification $150.00
September 15 – October 3, 2014 NCSHP-Raleigh, NC Instructor $1,795.00
September 22 – October 3, 2014 NCSHP-Raleigh, NC Operator $1,495.00
September 25, 2014 NCSHP-Raleigh, NC Instructor Re-Certification $150.00
October 13 – October 31, 2014 Redding, CA Instructor $1,795.00
October 20 – October 31, 2014 Redding, CA Operator $1,495.00
October 23, 2014 Redding, CA Instructor Re-Certification $150.00
December 1 – December 19, 2014 Arlington, TX Instructor $1,795.00
December 8 – December 19, 2014 Arlington, TX Operator $1,495.00
December 11, 2014 Arlington, TX Instructor Re-Certification $150.00
> Visit http://nucps.northwestern.edu/motorcycles <
For current class availability, tuition cost and to register on-line

Application for Enrollment
I wish to enroll in the following course:
Police Motorcycle Operator Training $ 1,495.00
Date
City
Police Motorcycle Instructor Training $ 1,795.00
Date
City
Police Motorcycle Instructor Recert. $ 150.00
Date
City
Name and Rank/Title:
Rank/Title:
Mr. Ms.
First Name M.I. Last Name
Personal Information:
Location where you may best be reached: Home Business Office Department Office
Street address at above location:
City, State, Zip:
Phone: ( ) Gender: M F
Email:
Apt/Suite:
Country:
Date of Hire at Current Agency
Billing Information:
Please indicate location where we may send all billing inquiries:
Agency/Business:
Agency Contact: Mr. Ms.
Street address:
City, State, Zip:
Phone: ( ) Fax: ( )
Apt/Suite:
Country:
Payment Information:
Purchase Order # OR Credit Card Type: AMEX MC VISA
Credit Card #:
Exp. Date:
Month
Year
It is the policy of Northwestern University not to discriminate against any individual on the basis of race, color, religion, national
origin, sex, age, or handicap in matters of admissions, employment, housing, or services in the educational programs or activities
which it operates, in accordance with civil rights legislation.
Return to: NUCPS Registrar or FAX to: (847) 467-0540
P.O. Box 1409
Evanston, Il 60204
http://nucps.northwestern.edu