Technical Training Associates
Workshop Registration
Refrigeration & EPA or R410A Certification
Workshop Location: Phoenix, Arizona
Workshop Dates: April 13th, 14th and 15th, 2011
COMPANY NAME _________________________________________________
STREET ADDRESS _______________________________________________
CITY ________________________________STATE _______ ZIP___________
Phone ___________________________ FAX____________________________
E-Mail ___________________________________________________________
ATTENDEES:
Name: ___________________________________________________________
Name: ___________________________________________________________
Name: ___________________________________________________________
Workshop Dates: __________________________________________________
Workshop Location: _________________________________________________
WORKSHOP FEE: $245 Per Person (Include EPA Certification or R410A Exam Fees)
Purchase Orders Accepted From Public Schools, Universities, Colleges, Government & Tribal Agencies
PO#___________________________
Check, Money Order, Visa, MasterCard, Discover & AMEX Accepted.
CREDIT CARD: ___ Visa ____MasterCard ____Disc. ____Amex
CARD # ________________________________________________________
EXP. DATE ______________ SECURITY CODE# __________________
SIGNATURE __________________________________________
Mail This Form To:
Technical Training Associates, HC 70 BOX 3172, Sahuarita, AZ 85629
Or Fax to 520-648-3334
Call 520-625-6847 to register by phone.
(Photocopy This Form For Additional Attendees)