Home (Click on Logo) 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 __________________________________________________