Colorado Fire Mechanics Association

STUDENT REGISTRATION FORM
2010 COLORADO FIRE MECHANICS ACADEMY
Mail the following paperwork to the Colorado Fire Mechanics' Assn: No application will be processed without completed form and payment. Tuition is $450.00 for non-members and $400.00 for members, per week or $100 per day. Add $100.00 for late fees after June 30th. All training hand-outs are included.

Mail to:
Colorado Fire Mechanics' Association
P.O. Box 17961
Denver, CO 80217


NAME___________________________________________________________SSN____________________________
                           LAST                                          M                                    FIRST                                      


HOME ADDRESS_________________________________________________________________________________
                                             NUMBER & STREET                                                                                            CITY                STATE                   ZIP


TELEPHONE______________________________________________________________________________________
                                   AREA CODE + HOME                                                  AREA CODE + WORK                                         AREA CODE + FAX


FIRE DEPARTMENT OR AGENCY___________________________________________________________________


JOB TITLE_______________________________________________NUMBER OF YEARS AT ACADEMY__________


EMAIL ADDRESS_____________________________________________________________


ARE YOU A MEMBER OF THE ASSOCIATION?   YES_____     NO_____
_________________________________________________________________________________________________

FILL IN CLASS SELECTIONS FOR EACH DAY BELOW.
CAREFULLY CHECK CLASS SCHEDULE FOR DAYS CLASSES ARE OFFERED!
Please include second and third choices.

                    MONDAY                                TUESDAY                              WEDNESDAY                            THURSDAY                         FRIDAY



1st CHOICE____________________|____________________|_______________________|______________________|________________


2nd CHOICE___________________|____________________|_______________________|_____________________|_________________


3rd CHOICE___________________|____________________|_______________________|_____________________|__________________

I WOULD LIKE A PRE-TEST FOR ELECTRICAL CLASS CFM215A_____________

CLASS CONFIRMATIONS WILL BE E-MAILED AFTER JULY 10th

Print This Form

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Registration closing date is July 1, 2010. Class size is limited and will be filled on a "first come, first served" basis. Please indicate your class selection(s) [and second choice (s)] on the registration form and submit it, with your payment ($450.00 non-members, $400.00 members for the week of classes, add $100.00 for payment received after June 30th to:

Colorado Fire Mechanics Association,
P.O. Box 17961
Denver Colorado 80217.