Basic Course Registration

Step 1 of 3: Course and Personal Information

This registration form consists of multiple parts. Unless otherwise noted, all items must be fully answered to continue registration. Note: If cookies are enabled in your browser, incomplete registration forms may be continued for up to 30 days.

Course

Available Dates

Personal Information

Name (First Middle Last)

Nickname or Changes (Optional)

Birth Date (MM/DD/YY)

Birth Place (City, State, Country)

Gender

Male

Female

Polygraph Practice Status

Private

Government

Law Enforcement

Contact Information

Personal

Phone

Address 1

Address 2 (Optional)

City

State

Zip

Country

Work/Business

Company

Phone

Fax (Optional)

Address 1

Address 2 (Optional)

City

State

Zip

Country

Questions

Have you ever been denied admission to or expelled from a polygraph training facility?

Yes

Have you ever been expelled from membership in any organization or society?

Yes

Have you ever been convicted of a felony, or if the charge was brought in a country other than the United States, an equivalent serious crime?

Yes

If yes, list the date, the nature of the offense or violation, the name and location of the court or place of hearing and the penalty imposed or other disposition of each case.

PEAK Credibility Assessment Training Center

1490 NE Pine Island Road, Unit 7B
Cape Coral, FL 33909
Phone: (765) 588-9224
info@peakcatc.com