To register, print this form. and either fax (518-899-5859) or mail (Pool & Spa Rx--18 Hills Road-- Ballston Lake, NY 12019) along with your payment. Register today!
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CPOŽ Registration application required to attend. Please include Check, Money Order, or PO-
*Required- for full registration Mail: Pool & Spa Rx--18 Hills Road-- Ballston Lake, NY 12019 |
| Course Date:_________________ Location:_______________________________________________ |
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*Last Name: First Name: *Home Post Office Mailing Address: (necessary for certificate)
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*Home Phone: *E-Mail: |
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*Company Name: *Position: |
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*Company Address: |
| Business Phone: *Business Fax: |
| CPO Certification # ____________________ Month ____ Year 199___ or 200__ |
| Send Confirmation via: Circle 1-------- E-mail Fax |
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Payment: Check#____________ Credit Card: CIRCLE 1: MC Visa DISCOVER or PO #______________________ Please circle the Credit Card you wish to use, and include your Card #, Exp. Date, & Security Code (Sec. Code) for processing. You must sign this authorization form for authorization so we may charge your account. PLEASE PRINT NAME AS IT APPEARS ON CARD (PRINT) __________________________________________________ Signature:____________________________________________________ CARD #___________________________________ Expiration Date: Month _______ 20__ Sec Code_______ IF YOU WANT A RECEIPT, YOU MUST INCLUDE YOUR E-MAIL ADDRESS: PLEASE PRINT CLEARLY- ____________________________________________________________________ Address if different from above: ______________________________________________________________ CPOŽ Training Manual (will be sent up to 14 days prior to training-to a home address only)- |
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Enrollment in each course is limited for maximum effectiveness and participation. Early registration is encouraged. Registrations are accepted in the order which they are received.
***Cancellation and refund policy
If cancellation is made at least three (3) weeks prior to the first day of the course, the registration fee less a $40 processing fee will be refunded to the registrant. Persons canceling after the three (3) week cut-off will receive a credit certificate adjusted for the cost of course materials, meals and other costs incurred by us. All cancellation requests must be made in writing and mailed, faxed, or e-mailed to Pool & Spa Rx. No-shows will be billed at the full rate. Submission of this application indicates agreement with these terms. |