Registration for KMDSI &/or PSI Class

SELECT START DATE OF KMDSI CLASS OR SIGN UP FOR CANCELLATION LIST/UPCOMING CLASS*

SELECT DATE OF PSI CLASS

Selected Courses

CITY, STATE ZIP

EMAILS

3 Day

4 Day

PSI

4 Day Dealer

5 Day Dealer

ATTENTION RECERTIFYING TECHNICIANS: TO RECEIVE 4 YEAR CERTIFICATE YOU MUST PROVIDE A CURRENT/VALID/NON EXPIRED CERTIFICATE NUMBER IN THE BOX BELOW*

First time Student OR my certificate has already expired - Receive 3 Year CertificateOther

STUDENT LEGAL NAME - FILL OUT THIS FORM IN ALL CAPITAL LETTERS*

FOR COMPANY PAID - LIST FULL NAME OF COMPANY, FOR SELF PAY - LIST INDEPENDENT*

ALL CAPITAL LETTERS

BUILDING NUMBER & STREET NAME*

CITY*

STATE*

ZIP*

IF OUTSIDE U.S - LIST COUNTRY

PHONE NUMBER*

FOR OUTSIDE U.S. INCLUDE 011

STUDENT EMAIL - REQUIRED*

AUTOMATED CONFIRMATION WILL BE EMAILED HERE

EMAIL OF A PERSON REGISTERING ON BEHALF OF A STUDENT

AUTOMATED CONFIRMATION WILL BE EMAILED HERE

List T-Shirt Size/Complimentary for KMDSI Class only*

Sizes Run Small/Recommend Sizing Up

Must explain form of payment, if OTHER is selected. Example: I will bring a company check*

I agree/will pay with credit card before start of classOther