Registration Form

Registration Form

Yes! I would like to register for:

CERT Train-the-Trainer Program

August 10, 11, and 12, 2010
8:00am - 5:00pm each day
Universal Studios Hollywood, Universal City

Required fields indicated with *

	BICEPP Member ($225)
	Non-BICEPP Member ($300)

*First Name
*Last Name
Title
Company/Organization
*Address
Address line 2
*City		* State * ZIP
*Phone
Fax
*Email

*Describe the CERT program you attended: authorizing agency, city, training location, dates, curriculum, etc.
Once your information is reviewed by our instructors, you will receive further information on course payment, directions, and parking.

To RSVP or obtain information regarding any of the above events,
please go to our Contact Us page.