Print this form and either fax or mail along with your payment. Register today!
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CPO® Registration Form—Please include Check, Money Order, or Copy of Purchase Order-Registration required to attend. No test results will be forwarded until payment is received and is due prior to certification submission. 2009
*Required- for full registration Mail: Pool & Spa Rx--18 Hills Road-- Ballston Lake, NY 12019 |
| *Last Name: First Name: |
| Business Phone: *Business Fax: |
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*Company Name: |
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*Company Address: |
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*Home Address: (necessary for certificate) |
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*Home Phone: *E-Mail: |
| ***CPO Certification # ________________________ Year 199___ or 200__ |
| Send Confirmation via: Circle 1 E-mail Fax |
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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. CIRCLE ONE: MasterCard Visa PLEASE PRINT NAME AS IT APPEARS ON CARD (PRINT) ______________________________________________________________________ CARD #______________________________________________________________ Sec Code_______ Expiration Date Month _______ Year 20__ IF YOU WANT A RECEIPT, YOU MUST INCLUDE YOUR E-MAIL ADDRESS: PLEASE PRINT CLEARLY- ____________________________________________________________________ Address if different from above: __________________________________________________________________ Signature:_____________________________________________ CPO® Training Manual (will be sent up to 14 days prior to training)- |
| Course Date:_____________ Location:____________ |
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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 a cancellation is made three 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 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. |