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Registration

*Class registration requires immediate payment with Paypal.

Class\Event: Test Class Cost: $1.00
Where: Champaign, IL When: 01/01/2096 05:30 AM to 01/03/2096 02:00 AM

(*) Denotes a required field

Last 4 SSN: XXX-XX-* Last 4 of SSN is required.
Last Name: * You must enter your last name.
First Name: * You must enter your first name.
Address: * You must enter your address.
City/State/Zip: * You must enter your address.
Email: * You must enter your email.

Department: * You must enter your department.
Dept. Address: * Dept. address required.
Department
City/State/Zip:
* Dept. address required.
Dept. Phone: * You must enter your dept phone.
Dept. Fax:
Training Officer: * You must enter your TO.
Please Book Hotel:*


*Your hotel room will be booked within a block designated for registrants of this class/event. You will be responsible for paying for your room if you do not attend the class or if the room is not canceled before the check in time. A letter with your hotel information will be mailed to you a few weeks before the start of the class. For any questions regarding this please contact admin@ill-fireinstructors.org

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