Laserfiche WebLink
Jan. 7, 2011 5:38AM <br />No. 3224 P. 3/4 <br />PPG. BUSINESS DEVELOPMENT CENTER REGISTRATION ION FORM. <br />This form must be completely filled out to properly register you for class. <br />Participant <br />Social Security #: (LAST 4 DIGITS ONLY) <br />Name: <br />Home <br />Address: .1 c..� ��► <br />City' State: y°'rs.,X..1 Zip: ,S.` ci"'°� <br />Home Phone Number. (--1 (z,3) �� _ -� <br />Job Title: C� <br />Do you you have a minimum of one (1) year technician <br />experience in a collision repair facility and are you familiar <br />with basic paint application techniques? yes Li no <br />Do you have any health concerns which may prohibit your <br />participation in any hands-on activities involving application <br />of refinish products? Li yes jno <br />what. If yes, are they? <br />,. �...._ ... ...,.., .._._ <br />1- Signature: <br />``f <br />Date: '"S <br />Company / Employer <br />Name: l_...�A�¢ vas NkNTd ("):c>- <br />Address: \.��.y��s..C,.t�. %-rJ <br />City: C2._A Z. ,--\1 State: vvsor.i Zip: ( <br />Phone Number: <br />Fax Number: cam \ <br />Certified First [� <br />City: <br />count #: <br />Sponsoring Jobber <br />Name: 4�ti t'v; T r,ott <br />N ip k=-TALL 5, Oil ,V <br />ture <br />PPG Territory Manager <br />Class Desired: <br />Date: <br />Location: <br />P.O.# <br />Class Information <br />Cc, l-- Cf_ <br />(First Choice) <br />E <br />(First Cho1co) <br />• State: <br />Date <br />Territory # <br />(Second Choice) <br />(Second Choice) <br />e For list of available classes contact Faxback at <br />1-800-450-2654 or www.ppgrefirtish.com. <br />• You will be invoiced through your sponsoring <br />jobber. <br />✓ For product -related classes, travel/lodging <br />arrangements: and costs are the participant's <br />responsibility. <br />m Do not snake airline reservations until you <br />have received written confirmation. <br />Cancellation Notice <br />Please remember you must cancel your class <br />registration three (3) business days prior to start of <br />class, otherwise a "No CaII - No Show" will result in <br />PPG billing you the full cost of this class. <br />Please fax or mail this completed application to: <br />PPG Business Development Center <br />7715 Parklawn Ave <br />Edina, MN 55435 <br />Phone: 952-831.3181 <br />Eax:952-831-5606 <br />Faxback 011111 Revised 6/6/01 <br />