Registration Form

Registration Form

(Please Print Form and Fax to the Number Below)

Your Premier Training Company

for the 9-1-1 Industry.

Names as you would like them to appear on certificates Title/Position

1) ___________________________________________________________________________

2) ___________________________________________________________________________

3) ___________________________________________________________________________

4) ___________________________________________________________________________

______________________________________________________________________________

Contact Person and Agency Name (no abbreviations please)

______________________________________________________________________________

Address

______________________________________________________________________________

Email Address

______________________________________________________________________________

Phone Number

Please Fax registration form toll-free to 1-866-852-0072

Or Mail to: Success Communications Inc.

313 Lansing Street, Suite #1

Charlotte, MI 48813

You will receive your confirmation via email and an invoice via US Mail.

Questions? Call 517-543-6141 or email Info@SuccessCommunicationsInc.com

Cancellation Policy: Cancellations made more than 2 weeks in advance will be credited toward a future class for someone from your agency.

Cancellations made less than two weeks in advance will not be credited or refunded. A substitute may be sent.

Pricing Information: One Day Classes: $229/person

2008/2009 Two Day Classes: $329/person

Three Day Classes: $489/person

Five Day Classes: $689/person

Date of Class Name of Class

___________ _____________________________________________

Price _______

Times # of Registrations _______

Total _______