<p> Superintendent Career Training Registration Form</p><p>FAX FORM TO: 702-938-1122 Attn: Dale Shoemaker</p><p>Requested Program Date:</p><p>Oct. 20-22, 2011 Feb. 2-4, 2012 May 17-19, 2012 June 28-30, 2012</p><p>Trainee Name: </p><p>UBC Local #: UBC ID #:U- Current Position: </p><p>Are you a UBC Member? Yes No I am a: Journeyman Apprentice</p><p>Home Phone: Work Phone: </p><p>E-mail: </p><p>Mailing Address: </p><p>City: State: ZIP: </p><p>Mentor: E-mail : </p><p>Position/Title: Phone: Fax: </p><p>Mailing Address: </p><p>City: State: ZIP: </p><p>Corporate Sponsor (Company Name): Contact: </p><p>Phone: Fax: </p><p>E-mail: </p><p>Mailing Address: </p><p>City: State: ZIP: </p><p>This Registration Form must be faxed 45 days prior to the start of class.</p><p>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]</p><p>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.</p>