NTL Alaska Registration Form

FULL

SPRING 2012 - NTL ALASKA, INC. COURSE REGISTRATION FORM

Name:			Company:
Address:			Phone:
City:			Fax:
State:		Zip:	Email:
	I would like to receive my confirmation by:		U.S. Mail, Fax Email

	Check this box if you would like to receive future course announcements by email only.

	Form of Payment:
	Check (Print form and mail with payment)		#________
	Purchase Order		#________
	Credit Card (We will call you for your number, please sign below.)
	_________________________________________

Registration is payable in advance. Payment will be refunded in full in the event NTL Alaska cancels a class. Refunds requested within two weeks of the course will be charged a 25% cancellation fee, except State of Alaska exam fees, which will be refunded in full. Classes may be canceled at any time. A confirmation letter will be sent to you outling the location and times of the class. If you do not receive this letter within 7 days of your registration please contact NTL Alaska to ensure the course is being offered and space is available. Companies or organizations with open accounts at NTL Alaska may use a purchase order to reserve class space.

Textbook is included in the course fee.
Please make sure to mark class button, location button and exam buttons to assure your complete registration

ALASKAN WATER TREATMENT SYSTEMS - Intermediate Level

This course offering is being sponsored by ADEC. There is no cost for registration, but the class registration is limited to 25 attendees. Checks for the exams should be made out to the State of Alaska and presented to the proctor at the time of the exam. Credit cards cannot be accepted.

Taking Exam? Select Level

ADEC Sponsored - February 13-16, 2012 - Bethel, AK (limited to 25) Exam Date 2/17/12
ADEC Sponsored - March 19-22. 2012 - Sitka, AK (limited to 25) Exam Date 3/23/12
ADEC Sponsored - May 21-24, 2012 - Kodiak, AK (limited to 25) Exam Date 4/25/12

Exam

ALASKAN WASTEWATER TREATMENT SYSTEMS - Intermediate Level

This course offering is being sponsored by ADEC. There is no cost for registration, but the class registration is limited to 25 attendees.

ADEC Sponsored - March 13-14, 2012 - Barrow, AK (limited to 25)
ADEC Sponsored - February 28-29. 2012 - Anchorage, AK (limited to 25)
ADEC Sponsored - March 27-28, 2012 - Fairbanks, AK (limited to 25)

INTRODUCTION TO ALASKA SMALL WASTEWATER SYSTEMS $525.00

April 23-26, 2012 - Fairbanks, Alaska (Provisional Level 1) If signing up for exams, select one or two exams: Exam Date 4/26/12
State of Alaska Application fee ($20) and one (1) exam ($30)		$50.00
State of Alaska Application fee ($20) and two (2) exams ($60)		$80.00
Wastewater Treatment Exam	Provisional Level 1
Wastewater Collection Exam	Provisional Level 1

INTRODUCTION TO ALASKA SMALL WATER SYSTEMS $525.00

April 9-13, 2012 - Anchorage, Alaska (Provisional Level 1) If signing up for exams, select one or two exams: Exam Date 04/13/2012
State of Alaska Application fee ($20) and one (1) exam ($30)		$50.00
State of Alaska Application fee ($20) and two (2) exams ($60)		$80.00
Water Treatment Exam	Provisional Level 1
Water Distribution Exam	Provisional Level 1

I WOULD LIKE TO RECEIVE MY TEXT IN ADVANCE $10.00
Not available for ADEC sponsored classes

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