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Exam Preparation Home Study (DVD Based 56 Hour Course) (2014 Code Edition) Class Sign Up Form
Location: Home Study
Class Instance ID: 7179
Document ID: 30A2 |
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.
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Standard Tuition Fee: $495.00
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Please print your information print clearly. * Required Information
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 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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Preferred GetWired! Onsite Lab Location:
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Sacramento
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San Diego
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Riverside (Riverside option available for 102 & 103 only. Labs unavailable in Riverside will be assigned to San Diego or the student's secondary preferred oniste lab location)
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Language:
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English
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Spanish
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Other
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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* |
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 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 $25 fee for all returned checks.
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/20 |
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| Credit Card Number |
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Expiration Date |
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3 Digit Security Code |
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| Print name exactly as it appears on credit card |
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Cardholder's Full Billing Address and Phone Number |
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$ |
| 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: 30A2
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