IEC Professional Development Series Registration Form

IEC Professional Development Series Registration Form

IEC of Kentuckiana
Use this form to register one person for one class. Submit a separate form for each additional class that you wish to attend. To sign up multiple people, email Amber Thieneman at athieneman@ieckyin.org.
Name

First NameLast Name
E-mail
example@example.com
Phone Number

Area CodePhone Number
Are you an IEC member?
Company Name
Select your employer from the list
License # -- if you would like to receive continuing education hours toward your license, enter it here:
Please include the first 2 letters (EE, ME, or CE) of your license #
Which Class are you registering for?
Select your CPR & First Aid Training class date:
Select your Test Prep class date:
Select your Conduiting Bending sessions:
Registration Fee

USDDescription