Print, complete and return registration form which is necessary for pre-registration.
Mail to: Maine Public Safety Training Consultants Fax to: 866-751-6495
PO Box 675
Brunswick, ME 04011-0675 E-mail: register@mpstc.com
(please add this e-mail address
to your address book)
Course Registration Form
Course:______________________________________ Date Of Course:_________________
Student Name:_______________________________________________________________
Department:_________________________________________________________________
Address:___________________________________________________________________
Phone:__________________________ Fax:_______________________________________
Department e-mail:____________________________________________________________
Department contact person:______________________________________________________
Purchase Order #:______________________________ Invoice to: Attention:_______________
If applicable
Personal check enclosed:_________
Personal contact information:
Best phone # to reach you:______________________________________
E-Mail Address:_______________________________________________
Indicate how you want your name printed on your certificate* (*Upon completion of course).
Upon receipt of your registration form a confirmation will be sent to you via e-mail.
If you have any further questions please contact either Rob Lane @ 751-3296 or
Bill Collins @ 751-3206