safehunters.com - Request Setup

* = required

First Name*

Middle Name or Initial

Last Name*

Address*

City*

State*

Zip*

Preferred Phone*

Alternate Phone

E-mail*

Date of Birth*
(Please use mm/dd/yyyy format
for example 01/02/1950)

Personal Notes

Instructor ID*
(This should be your
KDWP instructor ID#) It should be a five-digit
number with no letters before it - so, it could be
12345, but not H12345 or KS12345.

Password*
(Please use at least one upper case letter,
one lower case letter, and one number.
Must be 6-12 characters in length)

Enter Password Again*