Mississippi Law Enforcement Officers' Association

Complete this registration form and return it with your check, money order or purchase order made payable to M.L.E.O.A.   Return before May 15, 2012.

PLEASE PRINT THE FOLLOWING INFORMATION

Name:_______________________________________________________________

Agency:_____________________________________________________________

Address:____________________________________________________________

City:_________________________________State:________Zip:______________

Participant……….………….................................................................…………..$25

Additional Adults

Name:___________________________________________________________ $15

Name:___________________________________________________________ $15

Name:___________________________________________________________ $15

Children 16 and Under

Name/Age:______________________________________________________ Free

Name/Age:______________________________________________________ Free

Name/Age:______________________________________________________ Free

Total Amount Enclosed………………………………………………………..$_____

***Register for all events at the time of check-in***

Please return this form with payment by May 15, 2012, to:        MLEOA

                                                                                                C/O Charles Sims

                                                                                                14 Southgate Road

                                                                                               Hattiesburg, Ms 39401

8^th ANNUAL MLEOA POLICE MOTORCYCLE SKILLS TRAINING/COMPETITION

No Registration fees - This is included in the overall conference registration fee of $25.00.

Name:_________________________________________________________________

Home Address:__________________________________________________________

City:________________________  State:____  Zip:________  SS#_________________

DOB:________________        E-mail Address:__________________________________

Phone (Home):_____________________                (Work):_______________________

Department:_____________________________________________________________

Address:________________________________________________________________

City:________________________  State:____  Zip:__________

Emergency Contact:_______________________________________________________

Phone:__________________________________________________________________

T-Shirt Size: _____

Motorcycle Class (Check One)

____  Non-Fairing Motorcycle (wheelbase of 63-66 inches)

____  Fairing Motorcycle (wheelbase of 63-66 inches)

____ Other Motorcycle (wheelbase of less than 63 inches)

Rider Class (Please Check One)

___  Novice             Any Rider that has not competed more than three times or placed 1^st, 2^nd, or 3^rd in any motor competition.  

___  Intermediate          Any Rider that has competed at least three times, but not more than six times, or has not placed 1^st, 2^nd, or 3^rd as an intermediate.    

___  Expert                Any Rider that has competed in at least six motor competitions or placed 1^st, 2^nd, or 3^rd as an intermediate.

Riders must compete on a police motorcycle of at least 998cc, which is equipped in the normal deployment configuration.  No modification to the motorcycle for the purpose of this competition will be allowed.

Training and Practice will be June 7 – 9 during track hours.

Skills Exhibition Ride will be the afternoon of June 9.

If you have any questions, call:  Kane Kittrell at (601) 270-2119