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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 />`k Name: 1.—P. Q z <br />Home 1 <br />Address: \ '-1 '- L . \ A Cti-AA <br />City: Q + . 5 � State: .1-N., %\.1 Zip: ci <br />Home Phone Number. (--i (z, <br />Job Title: <br />Do 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? 1t yes ❑ 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 o <br />If yes, what are they? <br />"F' Signature: <br />Date: <br />Company / Employer <br />Name: (-10-0`'\ <br />Address: <br />City: �P. State: Zip:, es1, <br />Phone Number: <br />1 Fax Number; <br />Certified First <br />0 <br />Sponsoring Jobber <br />Name: A �� ,A; t <br />Gity: t .Lit. -TALL `>, 'oil ,v ' State: <br />count #: <br />D' tributor Sign, ture Date <br />PPG Territory Martiager Territory # <br />Mass Information <br />Class Desired: e...0„ <br />Date: <br />Location: <br />(First Choice) (Second Choice) <br />avvYLALr1t <br />(First Gholco) (Second Choice) <br />6 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 />r 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 Call - 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 />Fax: 952-831-5606 <br />Faxback 011111 Revised 6/6/01 <br />