Name (required)

Phone (required: format "xxx-xxx-xxxx")

Alternative phone

Email (required)

Address: street address, city, zip (required)

Emergency Contact:

Name:

Address: street address, city, state, zip

Phone number:

Email:

The cost of the course is $3,500, due at the time of registration. Payment can be made online or by cash or check. Admission is not secured until payment has been received and cleared. Full or partial scholarships may be available. Please inquire.

How will you pay for the program?

I have a sponsorI will pay for myselfI can't pay but would like to be on the waiting list for a scholarship

Sponsor agency (if sponsor payment is checked above)

Safety Equipment
Every candidate must come prepared with a hard hat, safety goggles, gloves and
steel toed safety shoes.

Comments (optional)