Water Conservation Ass.doc

Registration Form
Water Conservation CEU Training Course $
48 HOUR RUSH ORDER PROCESSING FEE ADDITIONAL $
Start and Finish dates:___________________________ You will have 90 days from this date in order plete this course
Name________________________________Signature__________________________
I have read and understood the disclaimer notice on page 2. Digitally sign XXX
Address:__________________________________________________________
City______________________________State_____________Zip____________
Email________________________________ Fax (____) ___________________
Phone:
Home (____) __________________ Work (____)_______________________
Operator ID# ____________________________Exp Date_________________
Please circle/check which certification you are applying the course CEU’s/PDH’s.
Water Treatment_____ Distribution_____
Other ________________________________
Your certificate will be mailed to you in about two weeks.
Technical Learning College
PO Box 420, Payson AZ 85547-0420
(928) 468-0665 Fax (928) 272-0747 Back-up Fax (928) 468-0675
Toll Free (866) 557-1746
info@
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American Express
Visa or MasterCard #_______________________________________Exp. Date_________
If you’ve paid on the , write your Customer #____________
Referral’s Name_____________________________________________________
Invoice me, PO # ________________________________
DISCLAIMER NOTICE
I understand that it is my responsibility to ensure that this CEU course is either approved or accepted in my State for CEU credit. I understand State laws and rules change on a frequent basis and I believe this course is currently accepted in my State for CEU or contact hour credit, if it is not, I will not hold Technical Learning College responsible. I also understand that this type of study program deals with dangerous conditions and that I will not hold Technical Learning College, Technical Learning Consultants, Inc. (TLC) liable for