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Wiring Motors and Air Conditioners - 2014 Code (8 hour course) Class Sign Up Form
Location: Online Classes
Class Instance ID: 7174
Document ID: 566D |
If you need to register with the state as an Electrician Trainee and you are enrolling with WECA for the first time or you are re-enrolling, please complete an ET program enrollment and initial class sign up form (Form Link: http://goweca.com/files/ETEnrollmentandInitialClassInfoandForm.pdf).
Standard Tuition Fee: $99.00
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Please print your information print clearly. * Required Information
* I am a(n): |
Electrician Trainee Certified Journeyman
General Student |
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First Name*
Middle Initial*
Last Name*
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Date of Birth*
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Mailing Address* | Apt #* City State Zip* |
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Primary Phone*
Home Cell
Other
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Secondary Phone*
Home
Cell Other
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SSN*
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Highest grade level completed* |
Ethnicity/Race |
Email Address |
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Gender: Male Female |
How did you hear about us? |
State Issued ID# |
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Preferences (Please choose one option from each of the following categories)
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Class Location:
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Rancho Cordova
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San Diego (*Get Wired - applies to on-site classes)
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Language:
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English
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Spanish
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Other
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Preferred Contact Method For Correspondence (If you do not select your preferred correspondence method, the default will be set for regular mail):
(For Class Schedules, Enrollment Confirmation Letters etc.)
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Email
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Mail
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Fax
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Are you currently employed by an Electrical Contractor? No Yes If yes, complete the following: |
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Contractor Name* |
Contractor Phone Number* |
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Contractor Mailing Address* City State Zip* |
If you are signing up for a Live Web Cast (LWC): Students must have an email address Have you reviewed the system requirements for the class? Yes No |
By signing this form, I understand and acknowledge that I have read the refund policy and that the initial ET enrollment fee is non-refundable. I certify under penalty
of perjury that all statements and information above are true and correct.
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Signature |
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Date |
Payment Method: Cash Check**
Money Order** Visa MasterCard |
 Coupon Code |
** Make payable to WECA. There is a $25 fee for all returned checks.
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Credit Card Number |
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Expiration Date |
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3 Digit Security Code |
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Print name exactly as it appears on credit card |
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Cardholder's Full Billing Address |
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$ |
Charge Authorization Signature |
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Date |
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Amount Authorized |
Remember to order your textbooks early so you will have them for the first day of class!
WECA Sacramento Region Office, 3695 Bleckely Street, Rancho Cordova, CA 95655 (877) 444-9322
www.goweca.com Document ID: 566D
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