C.O.P.S. Concerns of Police Survivors

| | | | | | | | | | |

National Police Week 2019


One registration form must be filled out for each HOUSEHOLD GROUP; i.e. family members with the same mailing address, arriving and departing at the same time, on the same date. If anyone in your group is arriving or departing on a different date, a separate registration form is needed. Please be sure to make copies for your records if you mail your registration.
Please provide the following information for the person completing this form.
Name badges will be generated from the information provided.

Title * First Name * Last Name *
Address * City * State ZIP/Postal *
E-Mail * You must provide an email address in order to receive your hotel confirmation(s).
If you are an agency filling out this registration, please enter the survivors email address.

Best Contact Number * Phone Type *
Have you attended National Police Week before? *

Your relationship to the fallen officer * If you are not a survivor, please select Supporter from the list of Relationships.
Your Officer's Name * End Of Watch *  


Other Household Members
List only the people in your household that will accompany you. Each household should complete their own form.

Number of Other House Hold Members: *
C.O.P.S. National Office

Mail:  P.O. Box 3199  --  Camdenton, MO 65020
Physical:  846 Old South 5  --  Camdenton, MO 65020
Phone:  573-346-4911  --  Fax:  573-346-1414
Email:  cops@nationalcops.org