Personal Information
*First Name:
*Middle Initial:
*Last Name:
*Employer:Or note "Self Employed"
*DOB:Your date of birth (mm/dd/yyyy)
Home Address Information
*Street Address:Your street address (e.g. 123 Main Street)
*City:
*State:
*Zip/Postal Code:
Work Mailing Address Information
*Street Address:Your work address (e.g. 123 Main Street)
*City:
*State:
*Zip/Postal Code:
Contact Information
*Email:Must be a valid email address
*Home Phone:In the format ###-###-####
*Work Phone:In the format ###-###-####
Fax:In the format ###-###-####
Courses
Check the appropriate date(s) for the course(s) you wish to attend.
GRADE "B" Operator's Certification Course ($575.00) More Info
Nov 26 - 30, 2018:
Nov 18 - 22, 2019:
GRADE "C" Water Operator's Certification Course ($525.00) More Info
Feb 11 - 14, 2019:
May 28 - 31, 2019:
Oct 7 - 10, 2019:
GRADE "D" Water Operator's Certification Course ($325.00) More Info
Oct 16 - 17, 2018:
Mar 14 - 15, 2019:
Jul 16 - 17, 2019:
Oct 22 - 23, 2019:
Supervision Course ($525.00) More Info
Jan 29 - Feb 1, 2019:
Jun 25 - 28, 2019:
Oct 29 - Nov 1, 2019:
Payment Method
Please choose your payment method. If you choose to pay with a credit card, you must fill in the credit card information below. PO, voucher, and check payments must be sent separately by mail.
*Payment Method:
Credit Card Information (For Credit Card Order Only)
Card Holder Name:Cardholder name if different from above
Credit Card Number:
Credit Card Type:
Card Security Code:
Expiration Month:
Expiration Year:
Submit Your Information
Note: Unless the ETC is notified of cancellation at least 2 business days prior to the course start date, you will be billed for the entire course.