KENTUCKY FIRE/RESCUE TRAINING CLASS REQUEST FORM

PLEASE COMPLETE AND RETURN TO ADDRESS/FAX BELOW

The ____________________________________________________________________

organization requests the following Fire/Rescue Training Classes:

Class Name	Category	Hours	OFFICE	USE ONLY
1.
2.
3.
4.
5.
6.

We request that the class be held during the month (s) of

_____________________________________________________________ 20_______.

( ) one night per week ( ) two nights per week

( ) weekends ( ) weekdays

( ) other _____________________________________________________________

Signed: (title)__________________________________________ Date: ____________

Day Phone: __________________________ Night Phone: ________________________

Email address: ________________________

Current address for schedule to be mailed:

____________________________________________________

____________________________________________________

____________________________________________________

SEND TO:

WILLIAM S. CARVER, COORDINATOR

FIRE/RESCUE TRAINING

1845 LOOP DRIVE

BOWLING GREEN, KY 42101

PHONE: (270) 901-1074, TOLL FREE 1-888-243-5760

FAX: (270) 901-1138

bill.carver@kctcs.edu

(REVISED 02/24/04)