October 2017 Technician Class Licensing Course
Please use this form to register for our next class to be held in the Town of Long Lake, October 14th and 15th, 2017.

Also PLEASE, register only one person per form. If you experience difficulty completing the form, you may register directly with the instructor, Scott Marriam, via email at kb2bdb@twcny.rr.com.

Email address *
Last Name *
Your answer
First Name *
Your answer
Phone number *
Please provide a contact number in case of course cancellation or schedule change.
Your answer
Mailing address *
House Number, Apt Number (if applicable) and Street
Your answer
City *
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State *
If your state isn't listed, please provide the 2 letter abbreviation for your state of residence.
Zip Code *
Your answer
How did you hear about our course? *
So we can analyze the effectiveness of our advertising, please let us know how you found out about this course.
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