*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:

Your Water Certification Number: 

Your Wastewater Certification Number: 

Your Plumber License Number: 

Billing information can be sent to an alternate address.
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:

Class Information

*Class L-#

*Class Name: 

*Class Start 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

*Class Location:  Select a Location Aberdeen, WA Auburn, WA Bellevue, WA Bellingham, WA Centralia, WA Edmonds Everett, WA Fife, WA Lacey, WA Moses Lake, WA Mt. Vernon, WA Pasco, WA Port Angeles, WA Puyallup, WA Richland, WA Seattle, WA Spokane, WA Tacoma, WA Vancouver, WA Wenatchee, WA Yakima, WA Other (city)

How would you like to pay for the class?

* Please Choose a payment option Visa/MC, fax / mail or call in the information ASAP. Purchase order (supply number below) Check/Money Order, Send to WETRC Immediately  

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.

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