Technical Training Associates: Workshop Registration Form

Refrigeration System Servicing & EPA (or R410A) Certification

Company Or Agency _______________________________________________

Street Address ____________________________________________________

City _____________________ State ________ Zip _______________________

Phone ____________________ Fax ___________________________________

E-Mail ___________________________________________________________

ATTENDEES:

Name: _________________________________________________

Name: _________________________________________________

Name: _________________________________________________

Workshop Dates: ________________________________________

Workshop Location: ______________________________________

Workshop Fee: $345.00 Per Person (Includes Certification Exam Fees & Take Home Workbook)

Check, Money Order, Visa, MasterCard, Discover & American Express Accepted.

Purchase Orders Accepted From Public Schools, Universities, Colleges, and Government Agencies.

PO# ___________________

Credit Card: ____Visa   ____MasterCard   ______Disc.   _______Amex (Security Code)_________

Card #_________________________________________________Exp Date_________________

Mail To: Technical Training Associates, HC 70 Box 3172, Sahuarita, AZ 85629

Or Fax To; (520) 648-3334