First Name Middle Name Last Name Organization (if applicable) Title (if applicable) Social Security # is required for clearance into Gulf Power Facility. Please call this in. FCDICE # (FLUSAR Classes Only for Florida Firefighters) Mailing Address City State Zipcode Phone Zipcode Which Course(s) Are You Registering For? INDUSTRIAL Confined Space &s; Structural Rope Rescue Operations - 45 HoursTechnician - 45hours Operations - Fee: $800 – Pre-requisite: None | Technician - Fee: $900 – Pre-requisite: Industrial Operations Level Date for above course: FLUSAR Rope Rescue Operations - 45 HoursTechnician - 45hours Operations - Fee: $700 – Pre-requisite: None | Technician - Fee: $700 – Pre-requisite: FLUSAR Rope Ops Date for above course: Confined Space &s; Structural Rope Rescue, Advanced Level – Pre-requisite: Rope &s; CS Tech Operations - 45 HoursTechnician - 45hours Operations - Fee: $500 – Pre-requisite: FLUSAR Rope Ops | Technician - Fee: $400 – Pre-requisite: FLUSAR CSR Ops Date for above course: Firefighter Self-Rescue Classes – Pre-requisite: Volunteer or Career Firefighter – Full Bunker Gear Required Full Class Fee: $900 Date for above course: INDUSTRIAL Confined Space &s; Structural Rope Rescue Full Class Fee: $2,500 Date for above course: INDUSTRIAL Confined Space &s; Structural Rope Rescue Escape – EXO - 8 HoursSurvival &s; Escape – 16 Hours Escape – EXO - Fee: $150 – Petzl EXO End-user Qualification | Survival &s; Escape - Fee: $300 – EXO, Escape Artist, RT Device Date for above course: Other Course Not Listed Above: Title Hours Dates Fee (if known) Method of Payment (Pre-payment Required): Card Number: Expiration Date: Security Code: Name as it appears on the card: Billing Address of Card (if different from above): Phone Associated with Card (if different from above): I understand registration cannot be secured without prepayment by one of the listed methods and that all course payments are final and non-refundable should I cancel during a period of time less than two weeks prior to the start date of my selected course. All course cancellations issued by Wright Rescue Solutions, Inc. will be refunded in full. I agree to the above statement. I Agree Today's Date
