PSTA Registration Form

Please complete the Registration Form below to register for a Public Safety Training Course.

1. All course registrations shall only be accepted via the online website registration form.

2. Students/Departments will receive a course registration acknowledgment via email, confirming the student(s) in the course.

3. Confirmation emails shall be sent out as soon as possible or at the PSTA Director’s discretion.

4. The PSTA has a 72-hour class withdrawal or cancellation policy from the start date/time of the course.

5. Failure to adhere to the cancellation policy will result in the student/department being billed for the roster spot.

6. Waitlists will be established when applicable. Every attempt shall be made by the PSTA to fill vacated seats utilizing this list and/or a social media posting.

7. Departments may substitute one member for another member who needs to withdraw, provided the cancellation is before 72 hours.

For questions, contact Director John Dixon
jdixon@sussex.edu or call 973-948-7897

Name & Course Number you are registering for? *

Attendee Information

FIRST NAME *

LAST NAME *

Last 4 digits of your Social Security # *

NJDFS ID # (if known)

DATE OF BIRTH *

Check this box if you are 16 or 17 years old

STREET *

CITY, STATE, ZIP *

PHONE NUMBER *

EMAIL ADDRESS *

GENDER *

Female
Male
Other

Fire/EMS/Police Department Information

Name of Organization

Organization Address

Chief of Department Information

Chief Name

Chief Phone

Chief Email

Chief Rank

Training Officer Information

Training Officer Name

Training Officer Phone

Training Officer Email

Training Officer Rank