Application
Medical Gas Installer/Brazer
| Name | |
| Social Security # | |
| Home Address | |
| City, State, Zip Code | |
| Home Phone # | |
| E-Mail Address | |
| Company Name | |
| Company Address | |
| City, State, Zip Code | |
| Company Phone # | |
| Company Fax # | |
Date(s) of Class Training____________________________.
I am applying for the above-mentioned Medical Gas Installer/Brazer Course. I can prove that I have at least 4 years of documented practical experience in the installation of piping systems. The cost of the class MUST be received within 3 (three) days of application. There will be NO changes or cancellations accepted within two weeks of class start date. NO Refunds will be given within two weeks of class start date. A minimum of 10 (ten) students are required to have a class. If the 10 student minimum is not met, all fees will be returned.
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Signature of Applicant Date
Please fax this application to (623) 434-0230
Or mail to 1831 W Rose Garden Lane. Ste. 1 Phoenix, AZ 85027
