Santa Barbara County Fire Department March 10th, 2010 Assessment Center (See Flyer)
	Santa Barbara County Fire Department March 11th, 2010 Simulator Workshop (See Flyer)
	Fremont Fire Department March 13th, 2010 Assessment Center (See Flyer)
	Fremont Fire Department March 14th, 2010 Simulator Workshop (See Flyer)
	Ontario Fire Training Center March 16th, 2010 Assessment Center (See Flyer)
	Ontario Fire Training Center March 17th, 2010 Simulator Workshop (See Flyer)

	Assessment Center Seminar	$110.00
	Simulator Workshop	$110.00
	Total:

*Cancellations must be made up to one week prior to scheduled class date.
No refunds will be made for "No-Shows". You may
be able to attend another scheduled class, space provided.

Check Mailed - Please include payment with copy of Registration Confirmation.

Visa or Master Card (3% service charge will be added)

Pay at The Door, Cash or Check $120.00 per Class Day

Bill My Department - Must have Department PO

* Arrangements must be made directly through me by email or by phone.
** Must have Department PO

First/Last Name:
Address:
City:
State:
Zip:
Department:
Phone #:
E-mail Address:

Billing Address First Name: Last Name: Company (optional): Street Address: Street Address (2): City: State/Province: Zip/Postal Code: Country: Phone:

Credit Card Credit Card Number: * Required Expiry Date: --Month-- January (01) February (02) March (03) April (04) May (05) June (06) July (07) August (08) September (09) October (10) November (11) December (12) / --Year-- 2008 2009 2010 2011 2012 2013 2014 2015 * Required CV2 security code: * Required On most cards, the security code number is the last three digits of the number printed on the back, at the top right of the signature strip.