Superintendent Career Training Registration Form

FAX FORM TO: 702-938-1122 Attn: Dale Shoemaker

Requested Program Date:

Oct. 20-22, 2011 Feb. 2-4, 2012 May 17-19, 2012 June 28-30, 2012

Trainee Name:

UBC Local #: UBC ID #:U- Current Position:

Are you a UBC Member? Yes No I am a: Journeyman Apprentice

Home Phone: Work Phone:

E-mail:

Mailing Address:

City: State: ZIP:

Mentor: E-mail :

Position/Title: Phone: Fax:

Mailing Address:

City: State: ZIP:

Corporate Sponsor (Company Name): Contact:

Phone: Fax:

E-mail:

Mailing Address:

City: State: ZIP:

This Registration Form must be faxed 45 days prior to the start of class.

For Additional Information, Contact: Dale Shoemaker, SCT Coordinator or Gretchen Malessa 6801 Placid Street 702-938-1111, ext. 2022 Las Vegas, Nevada 89119 E-mail: [email protected] Phone: 702-938-1111, ext. 2021 E-mail: [email protected]

IMPORTANT: Normal work attire required. No shorts, sandals, flip-flops or tank tops in class. Attendees dressed inappropriately will be required to change clothes to participate in class. Anyone then not complying will be removed from class.