EmailMe Form - LAPEER COUNTY MOUNTED SHERIFF's POSSE

Date Time

MM / DD / YYYY

Name

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone

### - ### - ####

Cell Phone

### - ### - ####

Email

Date of Birth

MM / DD / YYYY

Place of Birth

Marital Status

Married

Single

Driver License Number

Employement status

If employed, where?

Employer_____________________________ Kind of Work

Name of School..................Years Attended............Date Graduated.......Course

Name............... Address.......................Phone

Breed of Horse

Type of Saddle

Do you have a trailer?

Yes

No

How Long have you had horse?

How much time would you have to devote to the posse work?

Are you prepared to buy equipment ?

Yes

No

Have you ever been convicted of a felony

Yes

No

If you are accepted, are you prepared to abide be state laws of the State of Michigan?

Yes

No

Signature