2. Full Name*
4. Email
5. Daytime Phone*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Parent's Name*
15. Parent's Phone*
17. School Attending*
18. Grade Level*
20. Have you ever had any contact with the police or been arrested?*

    1. Yes
    2. No
21. If yes, explain:
23. Is any member of the family affiliated with a law enforcement agency?*

    1. Yes
    2. No
25. Name
27. Agency
29. Assignment
30. Contact Phone
32. Why do you want to be a member of Explorer Post No. 465?
34. Do you intend to seek a vocation in a law enforcement related field?*

    1. Yes
    2. No
36. If yes, state the type of agency or field:
38. Why do you seek employment in that particular field?*
40. What other organizations/activities are you involved in or a part of?*
42. Are you currently employed?*

    1. Full Time
    2. Part Time
    3. Not Currently Employed
44. Business
45. Title
47. Location
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field