2. 
4. Agency Name
5. Type of Agency
   -- Select One --LOCAL PUBLIC SAFETYCorrections DepartmentFire DepartmentPolice DepartmentSheriff DepartmentDEPARTMENT OF DEFENSEAir ForceArmyCoast GuardMarinesNavyFEDERAL LAW ENFORCEMENTDrug Enforcement AdministrationFederal Bureau of InvestigationUnited States Secret Service
7. Agency Address
9. City
10. State
11. Zip Code
13. 1. Team Captain Last Name
14. Team Captain First Name
16. Email Address
17. Mobile Number
19. T-Shirt Size
    -- Select One --SmallMediumLarge1X Large2X Large3X Large
21. 2. Team Member Last Name
22. Team Member First Name
24. Email Address
25. Mobile Number
27. T-Shirt Size
    -- Select One --SmallMediumLarge1X Large2X Large3X Large
29. 3. Team Member Last Name
30. Team Member First Name
32. Email Address
33. Mobile Number
35. T-Shirt
    -- Select One --SmallMediumLarge1X Large2X Large3X Large
37. 4. Team Member Last Name
38. Team Member First Name
40. Email Address
41. Mobile Number
43. T-Shirt
    -- Select One --SmallMediumLarge1X Large2X Large3X Large
45. Volunteer Last Name
46. Volunteer First Name
48. Email Address
49. Mobile Number
51. T- Shirt Size
    -- Select One --SmallMediumLarge1X Large2X Large3X Large
55. Challenge Coin Purchase
    CHALLENGE COINS are $10.00 EACH.
56. Information
    An entry fee of $200.00 is required per team. Make checks payable to Prince George's County Police Foundation, Inc. Mail entry fee to 6700 Riverdale Road Riverdale, Md. 20772 attn. Sgt. Bud Bergstrom. If you have any questions contact Sgt. Bergstrom at 240-695-3137 or bebergstrom@co.pg.md.us. For CREDIT CARD PAYMENTS you must call Sgt. Bergstrom.
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59. Email address

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