Registration Form Electrical Training
Complete Registration and Fax to
(888) 519-0752
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Next scheduled class in 2009
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Circle Payment Method:
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Check American Express Visa Mastercard Discovery
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Credit Card Number#:
4 Digit Security Code : Exp Date:
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Name(as it appears on credit card):
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Signature:
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Billing Address:
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Billing City
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Billing State
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Billing Zip Code
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NCHILB#
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Area Code + telephone Number: ( ) -
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Email Address:
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Emergency Contact
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Emergency Contact Area Code + Telephone # -
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Cancelation Policy - If cancel more than 30 days from seminar $20 process fee. If canceled within 30 days a $100 process fee with be charged. If canceled with 15 days of seminar $150 process fee. If a no show at seminar full fee will be charged. If canceled due to family emergency please contact us.