Class you wish to attend: Select One Grand Island, NE Sept 6-10, 2010 - Certification Grand Island, NE Sept 9, 2010 - Re-Certification Davenport, IA Sept 20-24, 2010 - Certification Davenport, IA Sept 24, 2010 - Re-Certification Lexington, NE Oct 11-15, 2010 - Certification Lexington, NE Oct 14, 2010 - Re-Certification Papillion, NE Oct 1-5, 2010 - Certification Papillion, NE Nov 4, 2010 - Re-Certification Davenport, IA Dec 6-10, 2010 - Certification Davenport, IA Dec 9, 2010 - Re-Certification
* Name:   Name:   Name:   Name:	* For: Select one Backflow Certification Training Re-Certification (CEU)   For: Select one Backflow Certification Training Re-Certification (CEU)   For: Select one Backflow Certification Training Re-Certification (CEU)   For: Select one Backflow Certification Training Re-Certification (CEU)
* Company or Organization:
* Address:
* City:	* State/Prov:
* Country:	* Zip/Post.code:
* Phone:
* E-mail:
* Registration Fee Calculator Backflow Tester $575.00 / each   0 1 2 3 4 5 6 7 8 9 10   Re-Certification Training $135.00 / each 0 1 2 3 4 5 6 7 8 9 10       Please pay this amount:
* Method of Payment: Select One Check Credit Card Money Order
Credit Card information MUST be called in to 888-305-5292. NOTE: Other methods of payment must include check or Money order number
Mail payments to: Total Backflow Resources P.O. Box 86 Salix, IA 51052
NOTE: Cancelations within 7 days of class start date will be refunded 50% of registration fee. Cancelations within 3 days of class start date will NOT be refunded. * denotes a field that must be completed BEFORE you click submit.