<p>2013-2014 Certificate in Fire Service ADMINISTRATION Registration Form □New student □Re-enrolling student I.D. ______Please complete all sections of this form. First Name: ______Middle: ______Last: ______Employer: ______Job Title: ______Telephone: Home: ( _____ ) ______Work: ______Cell: ______Fax: ______E-mail: ______Address (We require a street address for courier delivery): □ Work □ Home Street: ______City: ______Province: ______Postal Code: ______Instructions: Check the box next to the desired course choose either online or correspondence delivery. Tuition Fees Tuition Fees *ADD $50.00 after Online or Correspondence (3 courses) (1 or 2 courses) discount date Fall (September 4 - November 27, 2013) (*Aug. 7th, 2013) □ □ Emergency Medical Service Management and the Fire Department $ 895 .00 $ 945.00 ______□ □ Fire Department Human Resource Management $ 895 .00 $ 945 .00 ______□ □ Fire Prevention Management $ 895 .00 $ 945 .00 ______□ □ Municipal Finance $ 895 .00 $ 945 .00 ______For Experienced Incident Commanders (online only): □ Theoretical Foundations of Incident Command: Thinking (1st course) $1295 .00 $1295 .00 ______Winter (January 6 – March 28, 2014) (*Nov.13th, 2013) □ □ Fire Department Human Resource Management II (NEW) $ 895 .00 $ 945 .00 ______□ □ Fire Service Strategic Planning I $ 895 .00 $ 945 .00 □ □ Organizational Behaviour $ 895 .00 $ 945 .00 ______□ □ Program Evaluation and Statistics $ 895 .00 $ 945 .00 ______□ Theoretical Foundations of Fire Protection Planning I $1295 .00 $1295 .00 ______Spring (April 4 - June 26, 2014) (*Mar. 10th, 2014) □ □ Disaster Management and the Fire Department $ 895 .00 $ 945 .00 ______□ □ Fire Service Law $ 895 .00 $ 945 .00 ______□ □ Fire Suppression Management $ 895 .00 $ 945 .00 ______□ □ Municipal Government and Service Delivery $ 895 .00 $ 945 .00 ______□ Theoretical Foundations of Fire Protection Planning II $1295 .00 $1295 .00 ______For Experienced Incident Commanders (online only): □ Theoretical Foundations of Incident Command: Acting (2nd course) $1295 .00 $1295 .00 ______The following course is offered in the Fall, Winter and Spring terms: □ Fire Service Strategic Planning II (two term course) $1790 .00 $1890 .00 ______Method of Payment □ Cheque or Money Order to follow for $ ______(Payable to: Dalhousie University Fire Management Certificate Programs) □ Please bill my employer (ensure letter of authorization or purchase order is attached) Please charge my: □ Corporate Credit Card □ Personal Credit Card □ Visa □ MasterCard □ AMEX Card Number: ______Expiry Date: ______□ Pay By Term □ Pay All Three Terms. *Add $50 if you are registering after the early discount dates: Fall: Aug. 7th▪ Winter: Nov.13th▪ Spring: March 10th "I have read and understand the Financial Information section and agree to adhere to the regulations therein. I also understand that this program is governed by regulations developed and administered by Dalhousie University.</p><p>Signature: ______Date: ______Financial Information Withdrawal notification received prior to materials being shipped (usually 6-8 weeks before the start date) are refunded 80%, notification received after the materials have been shipped are refunded 50%. There is no refund on or after the course start date. All withdrawal notification must be in writing.</p><p>Please return this form to: For further information, contact:: Where did you get the information about Gwen Doary, Program Manager Grace Temani, Director the Certificate in Fire Service Administration: Fire Management Certificate Programs Fire Management Certificate Programs □ Co-worker Dalhousie University CCE Phone: 902.494.3531  Fax: 902.494.3662 □ Training Department at work 2201-1459 LeMarchant St., P.O. Box 15000 E-mail: [email protected] □ Fire Fighting Magazine Halifax Nova Scotia B3H 4R2 CANADA Website: www.continuinged.dal.ca □ Website Search Phone: 902.494.8838  Fax: 902.494.3662 Other (specify): ______E-mail: [email protected] </p>