What is your Title or Rank?
DSN/Badge #:
*Your Name:
*Your Email address (so we can reply to you
when we get you listed, get a free email account ):
Enter webpager ID name or number: Which webpager program do you use?
*Your Personal Home page:
*Title of your home page:
*Your City or County (which ever you
work for) Home page:
*Title of City or County home page:
*Your Departments Home page:
*Title of your Departments Home page:
*What Department Do you work at (include
the state)?
Department Mailing Address:
What is your
bosses' name & title (ie. Chief or Sheriff & name - highest ranking
official):
Main Department Phone Number:
Main Department Fax Number:
How Long have you been a Law Enforcement Officer?
population of service area:
Number of commissioned officers in your dept. (those with arrest powers):
How Did You Hear About This Page?
Additional Comments (ie. "we are already listed but, please change our
phone number from 555-5555 to 555-5510"):
Trouble sending this form? Send us e-mail with your info.
** NOTICE: to those requesting
a password: by sending this information you agree to abide by the laws set
forth by the state of Missouri and acknowledge you have read and understood
these laws. You further agree that the information you have provide
is true and accurate as RSMo
575.060 provides for the prosecution of those who provide false information.
Any person who falsely represents himself/herself as a law enforcement officer
may be prosecuted under RSMo
575.120. RSMo
569.095 also provides prosecution for persons who falsely gain, give
out the password, or give out information on the restricted area of moLEo.