Name:

SSN:

Mailing Address:

City:

State:

Zip Code:

Department/Organization/Company:

Day Phone:

Evening Phone:

Fax:

Course Selection

Please designate both 1^st and 2^nd choices by marking your selection in the 1^st choice column and the 2^nd choice column.

1^st Choice

2^nd Choice

Friday

Saturday

Sunday

Course and Length

8 hours

8 hours

Firefighter I (Essentials of Firefighting)  (16 hrs)

8 hours

8 hours

8 hours

Haz-Mat For First Responders, Operations  (24 hrs)

4 hours

8 hours

8 hours

Extrication Awareness & Operational (20 hrs)

8 hours

8 hours

NIFR Reporting / Passport Accountability (16 hrs)

8 hours

8 hours

8 hours

International Fire Code 2006 (24 hrs)

8 hours

8 hours

Specialty Training Package: Thermal Imaging, SCBA Confidence Maze, Electrical Safety and West Wendover Trailer(16 hrs)

8 hours

8 hours

Fire Apparatus and Pump Maintenance  (16 hrs)

8 hours

8 hours

Fire Officer Level I an II (16 hrs)

8 hours

8 hours

Principles of Building Construction Non-Combustible (16hrs)

8 hours

8 hours

Basic Trauma Assessment Course (16 hrs)

4 hours

8 hours

8 hours

Advanced Fire Arson Investigation  (20 hrs)

8 hours

8 hours

Foam Training (16 hours)

8 hours

8 hours

Wild land Training For Structural Firefighters, Crosswalk  (16 hrs)

8 hours

8 hours

High Angle Rescue (16 hrs)

Note:  Students are required to provide proof of Workman’s Compensation Insurance.

(Waiver’s for workman’s compensation insurance will NOT be accepted!)

Students taking any SCBA class must be clean shaven per NFPA 1403.  No exceptions!

Registration Fee: $45.00

You must register by February 8^th 2008.  No late registrations will be accepted!

One registration form per person.  Please make photocopies of this form if needed.

Total Payment Enclosed

(Your payment must accompany registration)

 Make Checks payable to: Southern Idaho Firefighter’s Assn.

Registration Fee  $45.00

Saturday Lunch   $11.00

Sunday Lunch     $11.00

Total Enclosed

Office Use Only

Date Received:

Payment (check #)