Public Safety Pros of Connecticut, LLC Class Registration Form
Registration form for Public Safety Pros of Connecticut, LLC Classes
Full Name (if Single Student)
As you would like it to Apear on Your Card
Your answer
Mailing Address *
Number, Street, City, State, Zip
Your answer
Mobile Phone *
(000)000-0000
Your answer
Students Names
if registering a group of two or more please list students below (as their names should appear on their cards)
Your answer
Contact Name
if registering 8 or more students
Your answer
Text Alerts *
Would you like to recive text alerts regarding classes? (i.e. Cancelations due to weather, etc)
Home Phone
(000)000-0000
Your answer
Work Phone
(000)000-0000
Your answer
Fax
(000)000-0000
Your answer
Your answer
Class Type *
Select the Class you are Registering for.
Class Date *
Enter the Date of the Class you are Registering for. (i.e. mm/dd/yyyy)
Your answer
Class Start time *
(i.e. 11am)
Your answer
Class Location *
Where is the class being held?
Class Location (Additional info)
Your answer
Website
Your answer
Twitter
i.e @yourusername
Your answer
Your answer
Payment Method *
Name on Credit Card
Your answer
Card Number
0000 0000 0000 0000
Your answer
Expiration Date
MM/YR
Your answer
Code(usually on back of card)
000
Your answer
Electronic Signature
Typed Name holds the same weight as my hand written signature, By entering my name below I give Public Safety Pros of Connecticut, LLC athority to charge the above credit card the full cost of tuition for the class selected above, I also realize that there is a additional 4% added for any aplicable Taxes/Processing fees. You will revice a recipt via email when your card is charged!
Your answer
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