Training Registration

Name:

Rank:

Date of Birth:

Status:

Phone:

Email:

Fax:

Agency:

Address:

City:

State:

Zip:

Course:

Total Cost:

Dates:

Do you have any medical conditions that we need to know about?:

If yes, please explain fully:

Billing Name:

Billing Phone:

Billing Address:

Billing City:

Billing State:

Billing Zip:

Payment By:

Agreement

IDEA, Inc. will provide instruction in the course under competent instructors and assumes no responsibility other than the opportunity to learn under suppervision. Acceptance of enrollment in a course constitutes an agreement to the conditions stated. IDEA, Inc. is hereby relieved of all liability. All courses are subject to cancellation. ALL REGISTRATIONS MUST BE RECEIVED 30 DAYS PRIOR TO COURSE. IDEA SCHOOLS HAVE LIMITED SEATING ON A FIRST COME BASIS AND TUITIONS ARE NON-REFUNDABLE.

Authorizing Supervisor:

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