Certified Playground Safety Inspector Registration Form Course Date

Certified Playground Safety Inspector Registration Form
Course Date – April 8, 9, 2015 & Exam Date – April 10, 2015
CPSI COURSE & EXAM REGISTRATION DEADLINE: FRIDAY, MARCH 6, 2015
Name
Employer
Mailing/Shipping Address
(no P.O. Boxes – books will be sent to this address)
City/State/Zip
Phone/Fax/Email
CPSI Current Certification #
CPSI COURSE & EXAM
o NRPS/NRPA Member: $575
o Non-Member: $650
CPSI EXAM ONLY
o NRPS/NRPA Member: $150
o Non-Member: $175
NRPA MEMBERSHIP #
Total Enclosed $
Payment Type
o Check #
o Credit Card #
Credit Card Info
Credit Card Type:
Exp. Date:
3-4 digit CVV2 code #
Billing Name & Address
City/State/Zip
Authorized Signature
s Fees Includes: Course Materials, Continental Breakfast on Wednesday/Thursday/Friday; Lunch and Snacks on Wednesday/Thursday.
s
Special Needs and Services: We are committed to meeting the needs of every participant. If you have unique needs that require special services, contact NRPS at 702-267-4140 or email NRPS@live.com and we will do our best to accomodate you. Accommodations cannot be guaranteed without 30 days notice. To ensure availability, all requests including dietary must be received by March 9, 2015.
s Cancellation Policy: Cancellation requests submitted prior to February 6, 2015 will be eligible for a partial refund. Textbook fees of $125.00 and a $100.00 cancellation fee will be retained by NRPS. No refunds or transfers after February 6, 2015.
Cancellation request must be submitted in writing via email to NRPS@live.com by February 18, 2015.
s Contact Information: NRPS P.O. Box 97264 Las Vegas, NV 89193-7264 Phone: 702-267-4140 Website: www.NRPS.org
Email: NRPS@live.com
s Minimum Registration: NRPS will ship course material when the minimum registration number of 40 is met. NRPS suggests that you secure airfare when NRPS has met the registration requirement. CPSI Course & Exam Location: Paradise Recreation Center, 4775 S. McLeod, Las Vegas, NV 89121.
INTERNATIONAL SHIPPING FEES WILL BE INCURED BY REGISTRAINT, please call for a quote.
NRPS reserves the right to cancel the course.