Fire School Signup

Fire School Signup Processing Error: form security violation Your registration for the 2010 State Fire School has been received by Nancy Sack (507-389-7217). Written confirmation will be mailed out at a later date. For your records, the information you provided is listed below. ================================================== Dept Name: #form.deptName# Chief Name: #form.chiefName# #form.address# #form.city#, #form.state# #form.zip# Station Phone: #form.stationPh# Station Fax: #form.stationFax# _________________________________________________ CONTACT PERSON: Name: #form.contact# Rank: #form.rank# Day: #form.dayPh# Night: #form.nitePh# Fax: #form.contactFax# Email: #form.email# ------------------------- PAYMENT: Method: #form.payMethod# Billing Add: #form.invoiceAdd# #form.invoiceCity#, #form.invoiceSt# #form.invoiceZip# _________________________________________________ STUDENT INFO: Name: #form.studName# Address: #form.studAdd# Phone: #form.studPh# COMBO Choices: 1st Choice: Sat AM: #form.coSatAm# Sat PM: #form.coSatPm# Sun AM: #form.coSunAm# 8 hrs: #form.coEightHrs# 12 hrs: #form.coTwelvHrs# 2nd Choice: Sat AM: #form.cTwoSatAm# Sat PM: #form.cTwoSatPm# Sun AM: #form.cTwoSunAm# 8 hrs: #form.cTwoEightHrs# 12 hrs: #form.cTwoTwelvHrs# 3rd Choice: Sat AM: #form.cThrSatAm# Sat PM: #form.cThrSatPm# Sun AM: #form.cThrSunAm# 8 hrs: #form.cThrEightHrs# 12 hrs: #form.cThrTwelvHrs# Dept Name: #form.deptName# Chief Name: #form.chiefName# #form.address# #form.city#, #form.state# #form.zip# Station Phone: #form.stationPh# Station Fax: #form.stationFax# _________________________________________________ CONTACT PERSON: Name: #form.contact# Rank: #form.rank# Day: #form.dayPh# Night: #form.nitePh# Fax: #form.contactFax# Email: #form.email# ------------------------- PAYMENT: Method: #form.payMethod# Billing Add: #form.invoiceAdd# #form.invoiceCity#, #form.invoiceSt# #form.invoiceZip# _________________________________________________ STUDENT INFO: Name: #form.studName# Address: #form.studAdd# Phone: #form.studPh# COMBO Choices: 1st Choice: Sat AM: #form.coSatAm# Sat PM: #form.coSatPm# Sun AM: #form.coSunAm# 8 hrs: #form.coEightHrs# 12 hrs: #form.coTwelvHrs# 2nd Choice: Sat AM: #form.cTwoSatAm# Sat PM: #form.cTwoSatPm# Sun AM: #form.cTwoSunAm# 8 hrs: #form.cTwoEightHrs# 12 hrs: #form.cTwoTwelvHrs# 3rd Choice: Sat AM: #form.cThrSatAm# Sat PM: #form.cThrSatPm# Sun AM: #form.cThrSunAm# 8 hrs: #form.cThrEightHrs# 12 hrs: #form.cThrTwelvHrs#

North Mankato 2010 Minnesota State Fire/EMS/Rescue School

CBI/Fire OnLine Registration Form

Your registration has been sent. You may enter a second registrant below or return to the CBI web site.

(To use OnLine Registration you will be asked to provide a valid Email address.)

DEPARTMENT INFORMATION (you will only enter this once.)
Department Name:
Chief Name:
Address:
City:
State:
Zip:
Station Phone:	(xxx-xxx-xxxx) & extension
Station Fax:	(xxx-xxx-xxxx) & extension
Contact Person:
Rank:
Day Phone:	(xxx-xxx-xxxx) & extension
Night Phone:	(xxx-xxx-xxxx) & extension
Fax:	(xxx-xxx-xxxx)
Email:	(required)

Method of Payment:	I will bring Payment Bill my Department or Agency I am Paying Personally
If billing Department please provide the following:
Send Invoice To:
City:
State:
Zip:

STUDENT INFORMATION (Each student will be entered separately.)

Student Name:
Student Address:
Student Phone:	(xxx-xxx-xxxx) & extension

Please indicate the COMBINATION of courses for your 1st, 2nd, 3rd choice.
1st Choice - Combination One
Sat AM
Sat PM
Sun AM
8 Hrs
12 Hrs
Second Choice - Combination Two
Sat AM
Sat PM
Sun AM
8 Hrs
12 Hrs
Third Choice - Combination Three
Sat AM
Sat PM
Sun AM
8 Hrs
12 Hrs