HVAC REGISTRATION SIGN UP FORM
HVAC THE COMMON SENSE WAY
AC MASTER T.E.C.H. METHOD
EPA TECH CERTIFICATION
HEAT PUMP SERVICE/REPAIR
APARTMENT MAINTENANCE
PARTICIPANT SIGN UP INFORMATION
STUDENT NAME:
JOB TITLE:
COMPANY NAME:
BUSINESS ADDRESS:
CITY / STATE / ZIP:
HOME PHONE:
BUSINESS PHONE:
EMAIL ADDRESS:
PRINT, COPY PER PARTICIPANT AND FAX THIS FORM TO 310 694-3710, ATTN: REGISTRATION DEPT
METHOD OF PAYMENT INFORMATION
COMPANY CHECK:
PURCHASE ORDER:
CREDIT CARD:
PAYMENT PLAN:
COMPANY BILLING INFORMATION
PURCHASE ORDER NO:
BILLING ADDRESS:
CONTACT NAME:
CREDIT CARD PAYMENT INFORMATION
CREDIT CARD TYPE:
(VISA/MASTERCARD/AMEX)
CARD NUMBER:
CARD EXPIRATION DATE:
TUITION FEES DUE & PAYABLE
PER PARTICIPANT TUITION DUE:
$
TOTAL TUITION DUE:
$
COMPANY APPROVAL SIGNATURE:
STUDENT PAYMENT PLAN SIGNATURE:
PROGRAM ENTRANCE INFORMATION
HVAC
THE
COMMON
SENSE
WAY
AC
THE
MASTER
T.E.C.H.
METHOD
EPA
APPROVED
TECH
TYPES I, II, III
CERTIFICATION
WELFARE
TO
WORK
INSTALLER
PROGRAM
HEAT
PUMP
SERVICE
&
DIAGNOSTICS
$
6
95.00
PER PERSON
$
555
.00
PER PERSON
$ 1
35
.00
PER PERSON
$2,499.00
PER PERSON
$ 550.00
PER PERSON
ADDITIONAL REGISTRATION INFORMATION
NUMBER OF STUDENTS TO ATTEND:
(25% DISCOUNT FOR MORE THAN THREE STUDENTS)
EXTRA STUDENT NAME:
EXTRA STUDENT NAME:
EXTRA STUDENT NAME:
Online Registration Form
HVAC
COMMON
SENSE
WAY
AC
MASTER
T.E.C.H.
METHOD
EPA
TECH
I, II, III
TEST
APARTMENT
MAINTENAN
CE
PROGRAM
W2W
WELFARE
INSTALLER
PROGRAM
HEAT PUMP
SERVICE
& REPAIR
