Basic Crime Prevention Printable Form

Print this form....fill it in and mail with your payment :

Basic Crime Prevention Certification Seminar

_____ May 5-16, 2008 - Louisville, KY

$1050.00 each or $950.00 if more than one participant from the same department.

Name:________________________________________

Position/Title:________________________________________

Department:________________________________________

Institution:________________________________________

Address:________________________________________

City:_________________________ State:_____ Zip:__________

Telephone: (____) _______________

FAX: (_____) _______________

_____Check Enclosed _____P.O. Enclosed _____Bill Me

Credit Card Number ___________________________ Exp. Date ___________
(American Express, Visa or MasterCard)

Mail To:
The AEGIS Protection Group
Campus Crime Prevention Programs
327 Townepark Circle
Louisville, KY 40243
U.S.A.

Telephone: (502) 244-7306
FAX: (502) 244-7308

Make Checks Payable To: AEGIS Protection Group, Inc.