Officer & Department Signup

If you are a D.A.R.E. Officer in Kansas and you would like to have your department or agency and its D.A.R.E. Officers listed here, please fill out the following form and submit the information.  Please fill out the form for each individual officer.

We especially would like to have an email account to send information to.   The K.D.O.A. and the state D.A.R.E. coordinator need your email address to contact you with important state program info, D.A.R.E. America updates, newsletters, etc.   It will be only for necessary communications and updates.   Your email account will be used only by the state coordinator's office and the K.D.O.A.   Your email address will NOT be published for general public viewing/spamming on the web.   It will not be sold or given away to any other third parties, companies or organizations.
Questions?  Contact the site webmaster at webmaster@kansasdare.org.

Officer & Department Signup

* Fields marked with * are required.

Title/Rank:  

  

First Name:  

 *

Last Name:  

 *

Department:  

 *

Website:  

  

Address:  

 *

City:  

 *

State:  

 *

Zipcode:  

 *

Phone:  

 *

Fax:  

  

Email Address:  

 *

*Note: This email account will be used for Kansas D.A.R.E. business only.

User Name:  

 *

Password:  

 *

Confirm Password:  

 *
     


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