FIRE SCHOOL REGISTRATION FORM
COST FOR CLASSES
1 – 2 DAY CLASS (12 – 16 HOURS) ----- $50.00 AFTER 4/22 $60.00
1 – 1 DAY CLASS (6 – 8 HOURS) -------- $30.00 AFTER 4/22 $40.00
2 – 1 DAY CLASSES (12 – 16 HOURS) - $50.00 AFTER 4/22 $60.00
CLASSES INCLUDE MEALS
LAST NAME _________________ FIRST NAME ___________________ SS# ___________________________
STREET ADDRESS _________________________________ HOME TELEPHONE _________________________
CITY __________________________ STATE _____ ZIP CODE _____________ DATE OF BIRTH ____________
E-MAIL ADDRESS ______________________________________________
DEPARTMENT NAME____________________________________ DEPT. TELEPHONE ____________________
CLASS NAME __________________________________CLASS LETTER _________ T-SHIRT SIZE __________
PAYMENT IS TO ACCOMPANY REGISTRATION FORM! MAKE CHECKS OUT TO NPFA OR NORTHERN PANHANDLE FIREMEN'S ASSOCIATION
MAIL TO:
William G. Wagner
P. O. Box 242
West Liberty WV 26074
Please send one form for each student!
Make as many copies as needed.