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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

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