Western Colorado IEC by hY7s1p0X

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									                                     Western Colorado IEC
                                     P.O. Box 1052
                                     Glenwood Springs, CO 81602
                                     Phone/Fax 970-984-3280
                                     Email WCIEC@QWESTOFFICE.NET

                                     Website WWW.WCIEC.ORG

                                Apprenticeship Training Registration Form
                                          First Semester – 2012 2013
 These forms may be copied as needed. Please complete one form for each student. Students interested in placement
                  testing should contact the IEC offices for scheduling prior to the registration deadline.
                Classes start the week of August 14, 2012. Registration deadline is August 8, 2012
           1st. year students must bring Driver License to the first class to complete registration

Student information:
Student Name ____________________________________ Social Security # _____ ____ _______

Address: __________________________________ City: __________________________ State: CO

Zip: _____________ Phone: _______________ Fax: ________________ Cell: ________________

Email Address: ___________________________
Please check one: ( ) New Student ( ) Continuing Student
Check year: ( ) First Year ( ) Second Year ( ) Third Year ( ) Fourth Year

Company Information: ( ) Member ( ) Non-Member

Company Name: ___________________________ Contact Person: __________________________

Address: __________________________________ City: __________________________ State: CO

Zip: _____________ Phone: _______________ Fax: ________________ Cell: ________________

Email Address: ___________________________

Students will be notified as to location of class, date of class & class hours.

Payment must be received prior to attending class. Tuition & Books must be paid with company checks only.

TUITION: per semester is: IEC Member - $550.00/student ($50 late fee applies)       $_________________
                          Non – Member - $1200.00/student_______________            $_________________
Books: subtotal                _____________________________________                $_________________
Tax: on books only (7.75% or tax exempt #)____________________________              $_________________

                                         TOTAL AMOUNT ENCLOSED:                     $_________________

REFUND POLICY: Please refer to Policies & Procedures, Page 4, Section 7.2.
CHANGE IN MEMBERSHIP: A Contractor must have paid three months membership dues to receive
membership prices. The contractor will be liable to pay nonmember prices for students and books if the
contractor drops their WCIEC membership prior to the end of the semester.

								
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