NYC / DOB 8-Hour Master & Special Electrician Renewal June 07, 2025 (In Person Class)

NYC / DOB 8-Hour Master & Special Electrician Renewal June 07, 2025

In Person Class
Please fill out info below and e-sign. Then Click Submit.
Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Address*

Business Name

Street

CityState / Province

Postal / Zip Code
Website
Picture of Front Drivers License*

Browse Files
Please take a clear picture from your Cell Phone and upload Cancelof
Picture of Front NYC License*

Browse Files
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Head Shot Photo of Self*

Browse Files
No Hats/ OnlyWhite Background permitted all others will be rejected. Cancelof
Gender*

MaleFemaleX
Eye Color*
Height *
Contact Person*
Telephone Number*

Area CodePhone Number
Cellular Number*

Area CodePhone Number
Email:*
example@example.com
Please select who is providing payment for class*
*If you are the business owner please select Self
Date of Birth*

MonthDayYear
Enter your date of Birth

My Products

(In person Class) June 07, 2025 8am to 5pm 65 Elm Street Copiague, NY 11726$250.00

Total $0.00

Credit Card

Apple Pay

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Date*

MonthDayYear
Date
Signature*

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By clicking "Preview PDF", you can preview the PDF of the Exempt Program Disclosure Form. Once you have read the form in full, please click submit to finalize your enrollment.
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