Backflow Assembly Training Services Hayden, Idaho Backflow Tester Certification Course                                                                              
                                      COURSE IS LIMITED IN SIZE - FILLS QUICKLY

Date: September 19 - 23, 2022  Times 8:00AM - 5:00PM daily (Pacific Time)
Location: Avondale Irrigation District / 207 E Hayden Avenue – Hayden, Idaho
Cost: $1100.00 if registered by SUPER discount date of August 1, 2022
          $1200.00 if registering between August 2, 2022 - August 19, 2022
          $1400.00 if registering after August 19, 2022 (if spots still available)

                                  Additional EXAM FEE of $165.00 fee for
               BOTH written and performance exams to be given on the final day of course
REGISTRATION DEADLINE - September 1, 2022  
  100% Refund if cancelled in writing by August 19, 2022  
                          50% Refund if cancelled in writing August 20 - September 1
NO REFUNDS will be given after September 1, 2022 -  (even if Covid related)
Registration MUST be done online WITH this form. INVOICE will follow AFTER REGISTRATION is received and can be paid with mailed in check or online with checking account or credit card. Credit cards will have 4% processing fee added.
                                               You CANNOT mail in registration
Questions? email           call or text 208 221 6988
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Student Name - Name on Gov issued ID (make sure this is correct) *
Student Mailing Address - INCLUDE City, State and Zip *
Phone Number(s) *
Employer information (optional) MUST have if they are being invoiced. Include Employer NAME MAILING ADDRESS, STATE, ZIP contact name & phone # and EMAIL ADDRESS
Is employer making payment? If yes see question above. *
How do you plan on paying? *
Purchase order # if needed
Plumber number if credits wanted
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