NSA On-line Class Enrollment Application - Texas '08

Applicant's Name (up to 5) & Social Security No. (required): Privacy Policy

Company Name:

Company Address :

City :
State : Zip:

e-Mail:
Phone:
Fax:

Class Location

Payment: Company Check, Visa, or Mastercard.
Checks must be received 72 hours before class date.

Member Pricing:
Level 1 - 16 hour class / 2 days $99.00
Continuing Education (CEC) - up to 8 hours $99.00 (take any parts, mix / match)
Fire Alarm 101 Test Prep (CEC) - 8 hour class $99.00

Non-Member Pricing:
Level 1 - 16 hour class / 2 days $179.00
Continuing Education (CEC) - up to 8 hours $129.00 (take any parts, mix / match)
Fire Alarm 101 Test Prep (CEC) - 8 hour class $129.00

Instant Annual Membership to NSA $95.00

Class Type: (choose only one)

Level 1 - 16 hour class
Continuing Edu (CEC) - 8 hour - Day 1 Ethics, Basic Alarm Install; False Alarm Prevention
Continuing Edu (CEC) - 8 hour - Day 2 Ethics, Fire Alarm, Central Station

Fire Alarm 101 Test Prep - 8 hour class - NFPA 72 Review; Ethics

Additional Items:

NFPA 72 '02 ed. book $50.00 (must either buy one here or bring your own to the class)
Late Registration (less than 72 hours before class) $20.00
Course Certificate Mounted on Wooden Plaque $19.95 (+ 5.00 s&h)

Comments: (if any)

Credit Card Number and Expiration: