WFA / WFR Recertification
Norwood, CO:
February 26 - 28

Wilderness First Responder Training:
Norwood, CO:
February 13 - 21

Wilderness First Responder Training:
Golden, CO:
April 16 - 18

WFA / WFR Recertification
Golden, CO:
April 30 - May 2

Wilderness First Responder Training:
Golden, CO:
May 14 - 16

Wilderness First Responder Training:
Durango, CO:
May 7 - 9

WFA / WFR Recertification
Durango, CO:
May 21 - 23

(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: $695.00; WFA/WFR/Recert Tuition $295.00*

WFR Deposit $300.00; WFA/WFR Recert Deposit: $100.00*

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: ________________