Form_1: BLUECARDINT Registration Form MASTER

CANADIAN, EUROPEAN, AND ASIAN
FIRE DEPARTMENT MEMBERS
Online Blue Card 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*
International Pricing (click based on your location)*

$385.00 USD for CANADIAN FIRE DEPARTMENTS$500.00 USD for EUROPEAN AND ASIAN FIRE DEPARTMENTS
How many Course Registrations*
Maximum 10 per Submission
For eleven (11) or more renewals in a single purchase, please email registrations@AOYSFireTraining.com for direct invoicing.

Blue Card Registrant No. 1
Blue Card Registrant No. 1 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

Blue Card Registrant No. 2
Blue Card Registrant No. 2 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

Blue Card Registrant No. 3
Blue Card Registrant No. 3 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

Blue Card Registrant No. 4
Blue Card Registrant No. 4 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

Blue Card Registrant No. 5
Blue Card Registrant No. 5 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

Blue Card Registrant No. 6
Blue Card Registrant No. 6 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

Blue Card Registrant No. 7
Blue Card Registrant No. 7 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

Blue Card Registrant No. 8
Blue Card Registrant No. 8 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

Blue Card Registrant No. 9
Blue Card Registrant No. 9 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

Blue Card Registrant No. 10
Blue Card Registrant No. 10 Information
First Name:*
Last Name:*
Department Rank:*
Contact Email Address*

STOPPER
Billing Summary
Method of Payment*
Billing Province (if Canada)*
Subtotal
US Funds Excluding GST/HST
Total Purchase
US Funds GST/HST Included
Total w/Credit Card Charge
US Funds GST/HST + 4% Transfer Fee
Credit Card purchases include an additional 4% transfer fee.
Purchase Order No.*
NOTE: All PO Orders are subject to verification.

Credit Card Payment

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

Payment Method
Credit	Express
Credit	What is PayPal?

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty: