Trent Institute for Watershed Science - Class 1 Electrofishing Certification Course Registration Form

Class 1 Electrofishing Certification Course Registration Form

General Registrant Information

NOTE: The registration deadline is May 3, 2010.

Name *

Position/Title *

Organization *

Mailing Address *

Email Address *

Telephone Number *
. . Ext.

Fax Number
. .

Please describe any food allergies or dietary restrictions:

NOTE: Course participants are strongly encouraged to bring their own backpack electrofisher including nets and extra batteries. If you cannot obtain this equipment to bring to the course, please indicate this below.

Are you bringing your own Backpack Electrofishing Unit? *

Yes
No

If yes, please indicate Back Pack unit type and model:

Type (e.g. Halltech)

Model (e.g. HT-2000)

Is this course for: *

New Certification
Re-certification

Registration Fee Payment

Are you Ontario Ministry of Natural Resources staff? *

Yes
No

Payment Amount:

Payment Method: *

PayPal
Invoice

Please Enter Your Purchase Order Number:

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Please type the verification phrase you see above, consisting of a colour, an animal and three numbers (case-insensitive). *
Why is this necessary?

* Indicates a required field.


Important: You have chosen "PayPal" as your payment method. When you submit your registration, you will be taken to the PayPal payment gateway to remit your secure online payment for the course.