Michigan Plumbing & Mechanical Contractor Winter 2017
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<strong>Michigan</strong> State Board of <strong>Plumbing</strong> & <strong>Michigan</strong> <strong>Plumbing</strong><br />
<strong>Michigan</strong> State Board of <strong>Plumbing</strong><br />
&<br />
<strong>Mechanical</strong> <strong>Contractor</strong>s Association<br />
<strong>Michigan</strong> <strong>Plumbing</strong> & <strong>Mechanical</strong> <strong>Contractor</strong>s Association<br />
APPLICATION<br />
APPLICATION<br />
2018 Backflow Preventer Training Program<br />
Student Name __________________________________________<br />
Home Street Address ____________________________________<br />
City, State, Zip _________________________________________<br />
Home Telephone _______________________________________<br />
Company Name ________________________________________<br />
Co. Street Address ______________________________________<br />
City, State, Zip _________________________________________<br />
Co. Phone ( ____ ) _____________ Co. Fax ( ____ ) ___________<br />
County ___________________ Co. Email ____________________<br />
Send Confirmation of Class Placement and Certificate Upon<br />
Completion to: ______________________ Title _______________<br />
Home Address<br />
Business Address<br />
Classes are from<br />
8:00 am to 4:00 pm<br />
All applications must include payment.<br />
Purchase orders not accepted.<br />
No Phone reservations taken.<br />
Please include mail<br />
stop or division/title if<br />
this will help assure<br />
you receive this<br />
confirmation.<br />
Sent via USPS<br />
Licensed Plumber? Yes___ No____<br />
If NO, a letter detailing<br />
Experience is required<br />
License Number: (Plumber license must<br />
be current & exp. date provided)<br />
Master: 81-_________________<br />
Exp. Date: __________________<br />
Journey: 82-<br />
Exp. Date:<br />
Email:<br />
___________________________<br />
Payment:<br />
Check one<br />
Member of MPMCA:<br />
Check enclosed for $1,020<br />
Nonmember:<br />
Check enclosed for $1,270<br />
To pay with credit card go to<br />
www.mpmca.org and select the<br />
“Shopping Cart” on the home page.<br />
Please INDICATE your 1 st , 2 nd , & 3 rd choice. If your first choice is not available, we will confirm your second choice. If<br />
your second choice is not available, we will confirm your 3 rd choice. Each class is limited to 20 students. MPMCA<br />
Members receive enrollment priority. Confirmation will be sent one month prior to confirmed class date.<br />
Declined checks/credit cards are subject to $25.00 service charge.<br />
____ Jan. 8-12, 2018 ____ April 9-13, 2018 ____ July 16-20, 2018 _____ Oct. 8-12, 2018<br />
MPMCA Members -- be sure to take your Member Discount!!<br />
Credit Card orders go to www.mpmca.org and use our convenient “Shopping Cart” -- Or<br />
Make your check payable to MPMCA and Return to:<br />
<strong>Michigan</strong> <strong>Plumbing</strong> & <strong>Mechanical</strong> <strong>Contractor</strong>s Association<br />
PO Box 13100<br />
Lansing, MI 48901<br />
Questions?? Call 517-484-5500 • FAX 517-484-5225 • Email info@mpmca.org<br />
Application form must be completed in its entirety to be considered for Class Placement<br />
<strong>Winter</strong> <strong>2017</strong><br />
<strong>Michigan</strong> <strong>Plumbing</strong> & <strong>Mechanical</strong> <strong>Contractor</strong> 29