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Central Maine Fire Attack School

 

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You will not be allowed to participate if this form is not signed!!
CMFAS
PO Box 143
Waterville, Maine 04903-0143
Or Fax it to: (207) 238-9229 

 

 REGISTRATION FORM

  Registration Deadline March 28, 2008

Type or Print Legibly -- This Information is Used to Produce Certificate

 Mail to:  PO Box 143

Waterville ME  04903-0143

or fax to:  (207)238-9229

 STUDENT NAME:

  

 SOC SEC #:

  

 HOME MAILING ADDRESS:

 

 

 HOME PHONE:

 DEPARTMENT:

 

 DEPT PHONE:

  

 DEPT BILLING ADDRESS:

 

 

 METHOD OF PAYMENT:

 

 Check # or Purchase Order #_______________________

 Course Cost   $115
 Includes Lunch

 Course Number
 1st Choice

 Course Number
 2nd Choice

 Course Number
 3rd Choice

 

I authorize this firefighter to attend these courses, certify that I am familiar with this firefighter and with the physical demands of the courses for which I have approved him/her.  I further certify that this firefighter is capable of the demands of the course for which I have approved this application, and that he/she is at least 18 years of age if applying for hands on training.

 

CHIEF OR AUTHORIZING SIGNATURE: