2011 STATE FIRE SCHOOL REGISTRATION FORM

• To Register: Using the drop down menu, make the proper selection for your 1st, 2nd and 3rd class choice in the far right column.
• Enter your costs and total dollar amount. Fill in the appropriate student information fields. Use "submit" button to register electronically or print a copy and use regular mail service.
• Registrations are confirmed on a first come basis, and confirmations will be sent to those who register by April 30th.
• "Hands-On" training restricts class size for quality as well as safety factors.
• Please closely review course descriptions located on the "Classes" page, for pre-requisites and necessary equipment.

COURSE SELECTION	Choose 1st, 2nd, or 3rd
Confined Space Operations	Make a selection..... 1st 2nd 3rd
West Wendover Fire Trailer and ROAM	Make a selection..... 1st 2nd 3rd
ROAM and West Wendover Fire Trailer	Make a selection..... 1st 2nd 3rd
PICO (Preparation for Initial Company Operations	Make a selection..... 1st 2nd 3rd
Fire Officer I Modules	Make a selection..... 1st 2nd 3rd
Instructor I Bridge Course	Make a selection..... 1st 2nd 3rd
Maps, Compass and GPS	Make a selection..... 1st 2nd 3rd
Wildland Interface S-215	Make a selection..... 1st 2nd 3rd
RT-130 Annual Wildland Refresher (Friday and Saturday)	Make a selection..... 1st 2nd 3rd
RT-130 Annual Wildland Refresher (Saturday and Sunday)	Make a selection..... 1st 2nd 3rd
Hazmat Operations- Railroad and Transportation Specific (Friday and Saturday)	Make a selection..... 1st 2nd 3rd
Hazmat Operations- Railroad and Transportation Specific (Saturday and Sunday)	Make a selection..... 1st 2nd 3rd

Call Jason Blubaum if you need addtional information or have questions regarding this registration. (208) 883-7082.

Registration Fee (1 Person)	$75.00 (includes 2 meals: Fri. Brunch & Sat. Lunch) $40.00 for one day 8hr course	FOR OFFICIAL USE
Friday Barbecue Ticket	x $10.00	DATE RECEIVED:
Saturday Awards Banquet Ticket	x $20.00	AMOUNT RECEIVED:
Extra Friday Brunch Ticket	x $ 9.00	CHECK/MONEY ORDER#
Extra Saturday Lunch Ticket	x $ 9.00
		RECEIVED BY:
ENCLOSED CHECK/MONEY ORDER	TOTAL COST:

MAKE CHECKS PAYABLE TO IDAHO STATE FIRE SCHOOL

Mail this form and/or payment to:

Jason Blubaum , 229 Pintail Lane, Moscow, ID 83843

Name (First and Last):	Daytime Phone:
Home Address:	Evening Phone:
City, State, Zip:	Spouse (if attending):
Affiliated Fire Department:	Email:

One Person per Form Please. Make photocopies of this page if you need additional forms.