Electrician Trainee (ET) Program

Class Sign-Up Form

Enrollment letter and confirmation will be emailed upon payment & registration into class.

Classes are subject to cancellation if minimum enrollment requirements are not reached.
Any changes to your class sign-up will be subject to ABC Northern California Chapter s Refund/Transfer Policies. Current Refund/Transfer Policies and forms are available at the ABC Northern California Chapter Offices, online at www.abcnorcal.org, or in our course catalog.

How did you hear about us?

Employment Information

Are you currently employed by an Electrical Contractor?*

Contractor Name

Class Information

Class Name* (instructions)

Class Start Date*

If you are signing up for a Live Web Cast class: Have you reviewed the system requirements for the class?*

By signing this form, I: (1) understand that the enrollment fee and initial class tuition fee are non-refundable and (2) give ABC Northern California Chapter permission to share information regarding my Electrician Trainee Program status with the State of California, ABC Northern California Chapter Members and/or my employer. (3) I understand and will abide by the ANC NorCal ET Student Handbook, the Lab Safety Policy, and the Student Participation Policy. I certify under penalty of perjury that all statements and information above are true and correct.

Signature Sign by typing full name*

Signature Date*

First name:*
Last name:*
Date of birth:*
SSN:*
Drivers license number:*
Gender:
Ethnicity:*
Veteran:
Street:*
Street 2:
City:*
State:*
Zip code:*
Primary phone number:*
Primary phone type:*
Email:*