*BAT Certification Number:  B

*Birth Date: Month: Month 01 02 03 04 05 06 07 08 09 10 11 12  Day:  Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  Year: 19

*Last 4 digits of your SS #: 

*Last Name:

*First Name:

Middle Initial:

*Gender: Male Female

*Daytime phone number:   -   ext:

E-mail: 

Confirmation letter will be sent to the address below 30 days prior to the class.

*Address 1: 

Address 2: 

*City:

*State:      *Zip Code:

Billing information can be sent to an alternate address.

*For Billing, Use Same Address as above? Yes NO, use info below:  (Billing address is required if you are using a PO Number.)

Attention: 

Employer Name: 

Billing Address: 

Billing City:

State:      Zip Code:

If you have a Water Certification number, enter it here: 
(3.0 CEUs)

If you have a Wastewater Certification number, enter it here:    (3.0 Relevant CEUs)

If you have a Plumber Certification number, enter it here: 
(Plumbers can now earn 4 Training Hours in this Class)

Class  Information

*Class  L-#

*Class Name:  Backflow Assembly Tester Refresher Class

*Date:  Month: Month 01 02 03 04 05 06 07 08 09 10 11 12  Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  Year

*Location:  (city)

*How would you like to pay for the Refresher Class?

  Please Choose a payment option Visa/MC Will call WETRC with CC # upon receipt of invoice Purchase order (supply number below) Check/Money Order, Send to WETRC Immediately (within 72 hours)  

PO Number (if applicable) 
(Billing address required if using a PO number.)

Please review your information for accuracy.  When you are satisfied with your data, press the <Submit> button below.  The process may take several seconds, depending on your connection speed.  Please press submit only once.

NOTICE, the EXAM is NOT included!  You must apply for the exam separately.  Visit www.wacertservices.org for more information.

On occasion class must be cancelled or rescheduled due to unforeseen circumstances.  WETRC reserves the right to make necessary changes to the schedule.