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PTC Security Training Academy



Registration Form



To register, complete the registration form below and make payment, in the form of a money order or check payable to.

PTC Security Training Academy
8754 S. Ashland Chicago IL 60620

NAME_________________________________________________________________

HOME STREET ADDRESS _______________________________________________

CITY __________________________STATE____________________ ZIP___________

Phone (home) _____________________ (work) _______________________________

Social Sec. No _________________________DOB_____________________________

Sex MALE____ FEMALE_____

COMPANY___________________________________________________________

COMPANY STREET ADDRESS ___________________________________________

CITY __________________________STATE____________________ ZIP___________

Course title:
Start dates Cost _____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Total cost___________



A 10 percent discount for multiple registrations of five or more from the same organization is available. In order to hold place in class a full deposit must accompany the application for admission. If a participant fails to attend the program for any reason the tuition fee will be refunded with the exception of a $20.00 non- refundable deposit.

STUDENTS MUST BE 18 YEARS OF AGE AND CAN NOT HAVE ANY FELONY CRIMINAL CONVICTION FOR THE LAST 10 YEARS. STUDENT MUST BE RESIDENT OF ILLIONIS AND POSSESS GOOD MORAL CHARACTER.



Signature __________________________________________________