Form_4: BLUECARDCAN Train-the-Trainer Registration MASTER

CANADIAN FIRE DEPARTMENT MEMBERS
Blue Card Train-the-Trainer Course Registration
Department Information
What is the name of the Fire Department or Company?*
Department Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Department Administrator
First Name*
Last Name:*
E-mail*
How many Course Registrations*
Maximum 8 per Course/Submission
Registration for Canadian Blue Card Train-the-Trainer Courses is
$4500.00 USD per registrant with a maximum of eight (8) registrants
in a standard sized class.
Trainer Session Location*

STOPPER
Billing Summary
NOTE: Payment for all Blue Card Train-the-Trainer Registrants must be received no less than thirty (30) days prior to the first scheduled day of the course. Refunds will not be provided for cancellations made less than thirty (30) days prior to the first scehduled day of the course.
Method of Payment*
Billing Province (if Canada)
Subtotal
US Funds Excluding GST/HST
Total Purchase
US Funds GST/HST Included
Credit Card purchases include an additional 4% transfer fee.
Total w/Credit Card Charge
US Funds GST/HST + 4% Transfer Fee
Purchase Order No.*
NOTE: All PO Orders are subject to verification.

Credit Card Payment

USDTotal Payment (GST/HST & Credit Card Fee Included)

Payment Method
Credit	Express
Credit	What is PayPal?

Department Information