Rev 3.12.18DGH CHECKS PAYABLE TO: Florida Fire Chiefs’ Association | | 880 Airport Road, Suite 110 | |Ormond Beach, FL 32174 386.676.2744 | |Fax 386.676.5490 | |[email protected] 2018 NATIONAL EMERGENCY VEHICLE TECHNICIAN TRAINING ACADEMY MAY 14-18, 2018 Advanced Technology College | 1770 Technology Boulevard |Daytona Beach, FL 32117 Attendee Name: Title: Department/ Agency Name: Mailing Address: City, State ZIP: Email: Cell Phone: Work Phone: 1ST /2ND /3RD CHOICES MONDAY TUESDAY WEDNESDAY THURSDAY 32 Hrs, M-Th Hale Pump -- - 24 Hrs, M-W M1 & M2 Management - Level I and Level II - Shop Management 16 Hrs, M-Tu F5 Aerial Fire Apparatus 16 Hrs, M-Tu F1 Insp/Maint/Testing Fire App - - 8 Hrs, M E0 Insp & Maint Ambulances 8 Hrs, M F4A Adv Electrical Systems 8 Hrs, M E4 Amb Cab, Chassis & Body 16 Hrs, Tu-W F3 Fire Pumps & Accessories - - 16 Hrs, Tu-W F6 Allison Automatic Transmissions - - 8 Hrs, Tu Pneumatics and Foundation Brake Fundamentals 8 Hrs, Tu E3 Amb Heat/AC/Air Vent Sys 16 Hrs W-Th F8 Fire Apparatus Hydraulics Systems 16 Hrs W-Th F2 Des & Perf Stds and Preventive Maint of Fire Apparatus 16 Hrs, W-Th F4 & E2 Apparatus & Ambulance Electrical Systems 16 Hrs, W-Th Brake Inspection, Maintenance, Troubleshooting, Compliance Validation 8 Hrs, W E1 Des & Perf Stds of Amb 8 Hrs, W Cummins Diesel 8 Hrs, Th Kussmaul Electronics 8 Hrs, Th F7 Foam Sys 8 Hrs, Th L1 Law Enf Veh InstTech FRIDAY E EV VT T C CE ER RT TI IF FI IC CA AT TI IO ON N T TE ES ST T: : Requires separate registration which is NOT included with EVT Academy registration. TEST # FL51818 ALL FEES AND REGISTRATION FOR THE CERTIFICATION EXAMINATION MUST BE MADE THROUGH Emergency Vehicle Technician Certification Commission, Inc. | PO Box 894 | Dundee, IL 60118 | Phone 847.426.4075 T TU UI IT TI IO ON N I IN NF FO OR RM MA AT TI IO ON N Registration includes Thursday afternoon BBQ. $465.00 – Full Package (Includes 5-day Symposium, Wednesday Dinner, Thursday BBQ, and EVT Section Membership thru September 30, 2019) $135.00 – Daily Registration (Includes Thursday BBQ) $40.00 x ______ Int’l Speedway Dinner Ticket (One included with Full Registration) GROUP DISCOUNT To qualify, submit at least 3 Full Registration forms at one time from the same Agency/Department. $365.00 Per Person – Full Package with Group Discount (Submit separate registration form for each attendee) P PA AY YM ME EN NT T D DU UE E: : $ $ *Check #: (Visa, MC, AmEx, Discover) Charge Card Number: Exp Date: CVV Name as it appears on card: Same as above Complete Billing Address: Same as above Email address for charge receipt: April 2018 FFS.QXD 4/10/18 1:52 PM Page 19