2008 Plumbing License Renewal Seminar Application

Name:_______________________________________________________________________		 License #:_________________________

Address:_____________________________________________________________________		 Home Phone:_____________________

City/Town:___________________________		 State:_______ Zip:________  Work Phone:_____________________
Check your seminar choice:
Mondays — 2008 -- 6 to 9 PM
Tuesdays — 2008 -- 6 to 9 PM

Jan. 7____
Mar. 3____
June 2____
Nov. 3____
Feb. 5____
Apr. 15____
Sept. 2____

Dec. 2____

Fee: $45.00 — 2 payment options

 

1.)  Enclosed is my Check for $____________    Make check Payable to:     KEENE SCHOOL DISTRICT

OR ...    

 

2.)  Charge   $____________                To my

(Check one):   MASTERCARD_______ or VISA_______

Please fill in all blanks:

Account
Number:______________________________

Expiration Date:_____________

Card ID #

______

« (last 3 digits, back of card right ofsignature box)

 

Cardholder’s Signature_____________________________________________ Date:_______________ 

Print this page, fill in the form and bring or send with payment to:  Keene Community Education, 438 Washington St., Keene, NH 03431.

FULL PAYMENT MUST ACCOMPANY FORM. You are automatically enrolled upon receipt of your check unless notified to the contrary. If you would like a receipt or confirmation, please enclose a stamped, self-addressed envelope with your registration.

You will be notified if any change in schedule is necessary. A minimum of 10 participants must be enrolled in order to run the session. The maximum enrollment for each class is 25.

Arriving 15 minutes or more late to class will require you to attend another seminar. Seminar fee will not be refunded or transferred and no credit will be given to the first seminar. Upon completion of the seminar, you will receive one certificate.

Click here to return to Plumbing License Renewal information page.