..:: Learning Stream ::..

All questions marked by an asterisk are required

Event Name:

Residential Wiring

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip/Postal Code:

*Phone:

*Email Address:

*Retype Email Address:

*Area of Teaching/Job Title:

*School/Organtization:

*Choose One:

You may be eligible for Perkins Scholarship if you are Post-Secondary.

Attached is a link for details.

Perkins Scholarship Application

*Method of Payment:

Bill Me
Purchase Order
Credit Card

Purchase Order Number:

Registration Fee = $150.00

How did you learn about this workshop?

*Photo Release - I grant KCCTE, its representatives and employees, the right to take photographs of me and my property in connection with the above-identified subject to possibly be used for publicity, advertising and Web content.:

Comments:

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