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PCIS 34: Erie County Pre-registration form

August 17th - 19th, 2026

**In the upcoming weeks, NYLEAP will contact you by phone to confirm your registration and provide specific details such as location address.**

Participants are responsible for reserving and paying for their own hotel accommodations (if needed); and are encouraged to stay at the designated PCIS hotel.

Upon confirmation by phone, we will provide hotel contact information where reservations can be made directly with the hotel at the negotiated rate. This includes breakfast. Departments/Agencies are asked to cover the cost of travel/lodging for their personnel. Lunch/dinner are provided at no cost during PCIS. NYLEAP is a 501(c)(3) Nonprofit organization.

Please inform us if you intend on bringing a service/therapy animal. Some venues—along with course logistics—make this an additional challenge that we need time to accommodate. Thank you.
1.Full Name - This will go on the training certificate(Required.)
2.Please list what name you would like listed on name tag
3.Address(Required.)
4.Department or Agency
This course is for First Responders or Military Veterans. If you are attending as a spouse or significant other please enter that here.(Required.)
5.I am a:(Required.)
6.Mobile phone
Do not use office phone or someone else's number. Please enter dashes. This is the number we will contact you on.(Required.)
7.Email address
(Do NOT use Department or Agency email)(Required.)
8.Any dietary restrictions?(Required.)
9.Very briefly describe the trauma/critical incident(s) that you find most challenging, or that you find yourself thinking of most often. Please don’t list “20+ years”, or “everything”, etc. A very brief explanation helps us with logistics. Thank you.(Required.)
10.We strongly encourage your significant other to attend. Please answer yes/no if your significant other is attending. Please have them fill out this form separately, so that we may have their information as well.(Required.)
11.Emergency Contact information (someone not in attendance).(Required.)
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