Transcription of BACKFLOW EDUCTION GROUP LLC
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BACKFLOW EDUCTION GROUP LLC
BACKFLOW EDUCTION GROUP LLC Back Flow Certification Application Applications Information First _____ M ____ Type of current certification _____ ASSE / ABPA_____ Last_____ expression date _____ Home Address:_____ current certification # _____ City: _____ State: _____ Zip_____ Phone: _____ Cell: _____ I acknowledge that I meet the prerequisite for this Certification Class BACKFLOW Prevention Assembly Testers: Please list Experience: A minimum of five years of experience in the plumbing field _____ BACKFLOW Prevention Assembly Repairer: Applicant must hold a current Tester Certification _____ Cross-Connection Control Surveyor: Must hold a current Testers Certification _____ Please note dates for the class you want to attend Class Location:_____ Registration fee: $_____ As of two weeks before the class, no refunds will be issued Class Date: _____ the information provided on this application is correct to the best of my knowledge.
BACKFLOW EDUCTION GROUP LLC Back Flow Certification Application Applications Information First _____ M ASSE / ABPA____ Type of current certification _____ _____
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