Community Risk Reduction
ATPC 3533
BFST approval # Pending
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Please complete information below
Date: ______________ Venue: Davie Fire Rescue
1. Participants information
Title: ____________ FCDICE # ______________________________
Name: ____________________________________________________________________________
Organization: ______________________________________________________________________
Address: __________________________________________________________________________
Postal/Zip code: ________________________ City: ____________________________________
Telephone: _____________________________________________________________________
E-mail:_____________________________________
*Please include a copy of your valid ID.
2. Workshop Fee $250.00
Paid directly to Instructor R. Goldenberg
There is no textbook for this course.
Fee includes workshop materials, Payment by check or cash.
Once registration form is obtained the Pre-course work will be distributed as acknowledgement of acceptance. Final date of registration is September 28, 2018
3. Notes
_________________________________________________________________________________
Date: _________/________/_________
Signature: _______________________________________
RETURN COMPLETED FORM DIRECTLY TO:
Angel Norris, Fire & Life Safety Division Clerk (954) 797-1229 anorris@davie-fl.gov
