|
Print this page to fax or mail |
||
| Click here to return to site | ||
|
NTS TRAINING FORM |
||
| FAX (814)-838-5127 | ||
| ATTN: Dale Eller | ||
|
MAIL FORM TO: NYBFAA |
||
| First Name ________________________________________________ | ||
| Last Name ________________________________________________ | ||
| Email Address ____________________________________________ | ||
| Employer (if applicable) ____________________________________ | ||
| Mailing Address 1 _________________________________________ | ||
| Address 2 ________________________________________________ | ||
| Address 3 ________________________________________________ | ||
| City _____________________________________________________ | ||
| State ____________________________________________________ | ||
| Zip ______________________________________________________ | ||
| Daytime Phone ____________________________________________ | ||
| Date of Birth ______________________________________________ | ||
| List Desired Level 1, 2A, 2B ____________________________ | ||
| Fee per class is $325.00 for members and $425.00 for non-members | ||
| Checks must be received seven (7) days prior to class date | ||
| Level 1 March 5, 12, 19, 26, 2003 | ||
| Level 2A April 9, 16, 23, 30, 2003 | ||
| Level 2B May 7, 14, 21, 28, 3003 | ||
| classes are 3:00 pm - 8:00 pm | ||