Registration Mail Form

Rapid Entry Systems Technology Corp.

Course Registration Form

Please print this form and fill in all the required information and send to the address below. If you are paying with a check please include it with this form. Under the persons column enter the number of persons you are paying for. The cost of tuition listed below is per person.

Registration deadline is 30 days prior to course start date with a minimum 50% deposit of tuition paid in advance.

Credentials for each (first time) attendee will need to be enclosed with this form along with an Application For Training for each attendee.

Code	Description	Tuition	Persons	Total
SE201	Special Entry Tech/Breacher 5 day Course	$1275.00	______	________
SE202	Special Entry Tech/Breacher 7 day Course	$1,700.00	______	________
XH203	Explosive Handlers 2 day Course	$425.00	______	________
			Subtotal:	________
			Deposit:	________
			Bal. Due:	________

Name: ____________________________________________

Billing Address: _____________________________________

City: __________________________ State: ___ Zip: _______

Phone: (____)__________ E-mail: ______________________

Card No:_________________________ Exp. Date__________

Visa___ MC___ AE___ Other___________________________

Check here if you are paying by Check __

Make checks payable to: Rest. Corp.

Thank you for registering.

Rapid Entry Systems Technology Corp.
P. O. Box 7093
Yuma, Arizona 85366
(928) 329-7555 Fax: (928) 329-7556