WFA/WFR Recertification:
Norwood, CO: December 16-18, 2011

WFA/WFR Recertification:
Golden, CO: December 9-11, 2011

WFA/WFR Recertification:
Norwood, CO: February 10-12, 2012

WFA/WFR Recertification:
Norwood, CO: April 20-22, 2012

WFA/WFR Recertification:
Golden, CO: April 27-29, 2012

Wilderness First Responder Training:
Golden, CO: May 11-13, 2012

WFA/WFR Recertification:
Golden, CO: June 8-10, 2012

(Please complete in full --type or print.)

Name _________________________________________________ Age _____ Sex : __ M__ F

What do your friends call you? ____________________Occupation: ____________________

E-mail address: ______________________________________________

Mailing Address _____________________________________________________________

City _______________________________________ State ________ Zip _______________

Phone (day) _____________________________ (evening) ___________________________

How did you first learn of First Lead's Trainings?: ___________________________________

Name of the our graduate who referred you to First Lead's training: _____________________________

WFR Tuition: $765.00; WFA/WFR/Recert Tuition $325.00*

WFR Deposit $350.00; WFA/WFR Recert Deposit: $150.00*

Make check or Money Order payable to: "First Lead".

* (For VISA / MC, an additional 4% will be added to this net (discount for cash) price)

Cardholder's name: ______________________ Signed:_____________________

Card Number: _________________________________ Expires: (MM/YY)_____________

Mail this form and payment to:
FIRST LEAD - PO Box 247 - Norwood, CO 81423
(Call First Lead at 970-729-0081 or email firstlead@centurytel.net if you have any questions.)
Early registration assures that we'll mail your textbooks to you before the training begins.
- - - - - - - - - - - - - - - - - - - - -please do not write below this line - - - - - - - - - - - - - - - - - - - - - - -

Deposit Payment $_____________ Date Rec'd__________ (Receipt # ______________) Balance due $ _______________

Final Payment $_______________ Date Rec'd_________ (Receipt # ______________) Text mailed: ________________