HomeMy WebLinkAboutNYS Academy of Fire Science- Residential Program RegistrationAcademy of Fire Science
Wential Program Registration
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HOME ADDRESS (STREET, PO BOX)
SPONSORING ORGANIZATION
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CITY
STATE ZIP
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HOME PHONE ( )
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DAYTIME PHONE 6 a 7 ) Z EC -- 74-5 Lt
Refer to the Course Schedule for
CAMP SMITH
specify START DATE from schedule
information about dates and
Vs
FEES:
COURSE REGISTRATION:
ACADEMY ACCOMMODATIONS:
•MATERIALS FEE (if applicable):
COURSE REGISTRATION FEE
MUST ACCOMPANY THIS FORM.
Registration fee is NONREFUNDABLE
In -state ($25)
Out -of -state ($50)
This does not apply to CAMP SMITH
See'M /L Chart below for cost.
(Refer to the Course Schedule for this number.)
(See reverse for additional instruction.)
�'X- for Meals and Lodging reservation
LUNOiI aNi y
Meals and Lodging fees
can be paid upon arrival.
(Cash also accepted for these fees upon arrival.)
See reverse for a complete
list of materials fees.
35
Materials fee
can be paid upon arrival.
'MIL (wLs Are Loww): MEwimm m 1=440 2480 34120 4=$160 54200 6= $240 8=5320 10 =$400 15=M 3041200 4041600
PAYMENT METHOD: ( "X" METHOD OF PAYMENT BELOW)
Checks and money orders ❑ Check ❑ MasterCard: TotalChaW: $
should be payable to the
Academy of Fire Science. ❑ Money Order ❑ VISA: Card Number.
Thank you. ❑ Signed PO /Voucher ErpiraHonDate:
❑ Other (specify): Signature:
PREREQUISITE PROOF if applicable) MUST ACCOMPANY REGISTRATION.
Send everything together to ... And, remember to enc lose ...
NYS Department of State • proof of completion of prerequisite course,
Office of Fire Prevention and Control If required (see Course Schedule);
Academy of Fire Science - appropriate fee; and
600 College Avenue - this completed registration form.
Montour Falls; NY 14865 -9634 Fax credit card registrations to (607) 535 -4841
Make additional copies of this Registration form as needed. Also available on the web at wwW.dos.slate.ny.us /fire /firewww.html
Pdces subject to change