| I am hereby enrolling in the following course
Check Box
Cost
Backflow Tester
Certification $525.00
Backflow Tester
Review & Recertification
$175.00
TOTAL_______________
PAYMENT
MUST BE MADE 2 DAYS PRIOR TO CLASS
Enrollments
at door (if space available) $20.00 additional
Reschedule Fee -Retake
fee: $150.00 cert, $75.00 re-cert
NO
REFUNDS -Retake Fee: $262.50
cert $87.50 re-cert
Enroll by
phone with Visa M/C Amex
Account:_________________________
Exp________________
Phone (954)
963-5444
Enrollment Fax
(954) 964-4533
|
Date____________________________
Name___________________________
Address_________________________
City____________________________
State_______________Zip__________
Phone___________Fax_____________
Recertification Tester Cert#__________
Email___________________________
Class good for 5 hours Continuing
Education for the CILB
Send checks to:
Institute for Cress Connection
Control
6750 Pembroke Road, Hollywood, Fl
33023 |