SPRING FIRE SCHOOL REGISTRATION FORM

RETURN REGISTRATION FORM AND PAYMENT ON OR BEFORE MAY 4
TO:
GEORGE SCRIMGER
M.S.F.A.
140 S. MAPLE LEAF RD.
LAPEER, MI 48446
E-mail gisfire@charter.net
Phone: 810-664-1336   FAX: 810-635-2858
Name ____________________________________
Street Address: _____________________________
City _____________________________________
State __________________ Zip _______________
Phone: Day( ___ ) __________________________
Evening ( ___ ) ____________________________
Fire Dept. ________________________________
NFIRS __________________________________

Method of Payment:

[] Check payable to MSFA

[] Discover
[] Master Card
[] VISA
[] American Express

_______/_______/_______/_______  Exp. _____/_____   Signature _____________________________

[] Billing Department
Chief's Name _______________________________Chief's Signature _____________________________

Class numbers: First Choice __________________ Second Choice ______________

CANCELLATIONS AFTER MAY 6 WILL BE CHARGED FULL TUITION. CANCELLATIONS MUST BE IN WRITING

EMERGENCY CANCELLATIONS REQUIRE LETTER OF EXPLANATION AND BOARD ACTION

*NFA Class #3 Deadline is April 15