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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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