SWAT Course Registration Form
SWAT Course Registration Form Personal Information Name:
Birth Date:
City:
Gender:
Social Security Number
Address:
State of Residence:
State:
County (Idaho residents only):
Zip: Phone:
Email:
Education High School:
College Status:
Institution:
H.S. State:
College Level:
State:
Graduation:
College Degree:
Date Received:
Select the course(s) you are registering for:
Fees are $50.00 per credit hour
Feb 23rd - Mar 13th 2009 | SWAT III | 4 cr | Denmark, SC
Mar 9th - Mar 12th 2009 | SWAT II | 1 cr | Boise, ID
Feb 17th - Mar 9th 2009 | SWAT III | 4 cr | Boise, ID
Mar 18th - Mar 20th 2009 | Type I | 1 cr | Denmark, SC
Mar 13th - Mar 18th 2009 | SWAT II | 1 cr | Denmark, SC Payment Information Check Credit Card
Check number: Name of Cardholder:
Credit Card Type VISA Card Number:
Expiration Date:
Cardholder signature: _____________________________________________
Date: _____________________
FOR OFFICE USE ONLY Amount received: _____________________________
Processed by: _________________________________
Received by: ___________________________________
Process date: _____________
Date: ___________________
Instructions for completing SWAT registration and submitting payment: To receive the optional college credits for the SWAT training, complete this form and submit payment as instructed below. Fill in the form electronically EXCEPT the signature for credit card payments and the signature to certify that the information entered is correct. THEN Print the completed form and sign for credit card payments on the signature line, if required, and sign to certify all registration and payment information is correct. OR Print the form and fill in the registration form by hand. Fax the completed forms to: Fax: (208) 282-5195 Attn: D. Ronneburg, SWAT Course Registration
Note: You must be concurrently registered with the Government Training Institute (GTI) for TYPE III Advanced SWAT. For questions regarding GTI registration, call ISU Institute of Emergency Management (208) 373-1758 or GTI at (208) 938-5510.
Payment Information
The fees for the optional ISU SWAT courses credits are at the reduced rate of $50 US Dollars (USD) per credit hour (normally $236 USD per credit hour). You may phone in credit card payments to ISU's Cashier's Office at (208) 282-2900. ISU only accepts MasterCard or VISA credit cards. If paying with check or money order, make it payable to Idaho State University and mail to: (Cash will not be accepted) Idaho State University College of Technology Attn: D. Ronneburg, SWAT Course Registration 921 South 8th Ave., Stop 8380 Pocatello, ID 83209-8380 Phone: (208) 282-2622
Birth Date:
City:
Gender:
Social Security Number
Address:
State of Residence:
State:
County (Idaho residents only):
Zip: Phone:
Email:
Education High School:
College Status:
Institution:
H.S. State:
College Level:
State:
Graduation:
College Degree:
Date Received:
Select the course(s) you are registering for:
Fees are $50.00 per credit hour
Feb 23rd - Mar 13th 2009 | SWAT III | 4 cr | Denmark, SC
Mar 9th - Mar 12th 2009 | SWAT II | 1 cr | Boise, ID
Feb 17th - Mar 9th 2009 | SWAT III | 4 cr | Boise, ID
Mar 18th - Mar 20th 2009 | Type I | 1 cr | Denmark, SC
Mar 13th - Mar 18th 2009 | SWAT II | 1 cr | Denmark, SC Payment Information Check Credit Card
Check number: Name of Cardholder:
Credit Card Type VISA Card Number:
Expiration Date:
Cardholder signature: _____________________________________________
Date: _____________________
FOR OFFICE USE ONLY Amount received: _____________________________
Processed by: _________________________________
Received by: ___________________________________
Process date: _____________
Date: ___________________
Instructions for completing SWAT registration and submitting payment: To receive the optional college credits for the SWAT training, complete this form and submit payment as instructed below. Fill in the form electronically EXCEPT the signature for credit card payments and the signature to certify that the information entered is correct. THEN Print the completed form and sign for credit card payments on the signature line, if required, and sign to certify all registration and payment information is correct. OR Print the form and fill in the registration form by hand. Fax the completed forms to: Fax: (208) 282-5195 Attn: D. Ronneburg, SWAT Course Registration
Note: You must be concurrently registered with the Government Training Institute (GTI) for TYPE III Advanced SWAT. For questions regarding GTI registration, call ISU Institute of Emergency Management (208) 373-1758 or GTI at (208) 938-5510.
Payment Information
The fees for the optional ISU SWAT courses credits are at the reduced rate of $50 US Dollars (USD) per credit hour (normally $236 USD per credit hour). You may phone in credit card payments to ISU's Cashier's Office at (208) 282-2900. ISU only accepts MasterCard or VISA credit cards. If paying with check or money order, make it payable to Idaho State University and mail to: (Cash will not be accepted) Idaho State University College of Technology Attn: D. Ronneburg, SWAT Course Registration 921 South 8th Ave., Stop 8380 Pocatello, ID 83209-8380 Phone: (208) 282-2622
