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User Account Request Form
ATTENTION: You are not eligible to apply for a LMS Account unless you are a member of Federal, State or Local Law Enforcement and have received approval by the appropriate Federal or State LMS Manager. You will be rejected if you do not meet both criteria. Thank you
Work Email
*
Used to create your username
Student Information
Student Name
*
First Name Last Name
Position Title
*
Does your position receive Federal Funding for commercial motor vehicle enforcement?
*
- Select a value -
No
Yes
Work Telephone Number
*
Student Address
Country
*
Canada
United States
Company
Address 1
*
Address 2
City
*
State
*
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Armed Forces (Americas)
Armed Forces (Europe, Canada, Middle East, Africa)
Armed Forces (Pacific)
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
Virgin Islands
ZIP code
*
Supervisor Information
Supervisor Name
*
Supervisor Telephone Number
*
Supervisor Email Address
*
Information from this form is used to grant you a user account on this system.
Leave this field blank
