Fillable 2021-2022 EXTENDED APPRENTICE TRAINING (Electrical Association)

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2021-2022 EXTENDED APPRENTICE TRAINING (Electrical Association)

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Part 1: TUITION & FEES (24-week course) Member Nonmember Amount
Motor Controls (PLC, VFD, HMI); Solar PV; 70E Safety; Exam Prep $1230 $1450
Late Fee after Sept 14. (Late registrants will not receive books or
login information in time for the rst class!)
$150 $150
Deduct the Early-Bird Discount if applicable.
Tuition Total:
Part 2: BOOKS & EQUIPMENT
Semester 1 Study Guide (Motor Controls: PLC, VFD, HMI) $72.50 $82.50
Semester 2 Study Guide (Solar PV; 70E Safety; Exam Prep) $72.50 $82.50
2020 NEC
®
Code Book and EZ Tabs™ $109 $112
Equipment: PLC Rockwell–Allen Bradley Micro 850 $525 $540
Equipment: VFD $190 $205
Optional: 2020 Ugly’s Electrical Reference $15 $16
Books & Equipment :
Shipping (add 6%):
Handling: $10
Subtotal:
Sales Tax on Subtotal:
(MN residents only—
add 6.875%)
Books & Equipment
Total:
Tuition Total:
TOTAL AMOUNT
DUE
2021-2022 EXTENDED APPRENTICE TRAINING
EARLY-BIRD DISCOUNT! Save $50—Register before July 9! Save $25—Register before July 30!
*Prices are subject to change without notice.
Check Enclosed Credit Card (Visa, MC, Discover)
CC # ____________________________________ Exp: _______ CV2: _________
Name on Card: ________________________________________________________
Billing Address: ________________________________________________________
Student Name: _____________________________________ Cell Ph: ___________________________________________
Address: _________________________________________ MN DLI Unlicensed Registered #: _______________________
(MN residents only)
City, State, Zip: ____________________________________ Student Email: ______________________________________
Ship my books to: Company Student
Company Name: ___________________________________ Business Ph: _______________________________________
Address: _________________________________________ Apprentice Admin (if applicable): ________________________
City, State, Zip: ____________________________________ Admin Email: _______________________________________
Please complete the Release of Grades Waiver with your registration form and return:
Email: info@electricalassociation.com • Fax: 612-827-0920
Unless stated otherwise, the Electrical Association staff and instructors who are involved in the design, development and delivery of our courses do not have
any proprietary interest in products, instruments, devices or materials that may be included in the course.
* 2 FREE CEs are available for registrants in this course!
Attention! Year-4 Graduates—Seats are Limited!
Start Date: Sept 23 • Registration Closes August 12!
Electrical Association
3100 Humboldt Ave S • Mpls, MN 55408
Ph: (612) 827-6117 • Fax: (612) 827-0920
www.electricalassociation.com
APPRENTICE INFORMATION
Name of Apprentice: ________________________________________________________
Address: _________________________________________________________________
City, State, Zip: ____________________________________________________________
Email Address (required): ____________________________________________________
Cell Phone: _______________________________________________________________
COMPANY INFORMATION
Company Name: __________________________________________________________
Company Address: ________________________________________________________
City, State, Zip: ___________________________________________________________
Name of Apprentice’s Administrator: __________________________________________
Email of Apprentices’s Administrator: __________________________________________
Phone of Apprentice’s Administrator: __________________________________________
RELEASE WAIVER & AUTHORIZATION
I hereby authorize the Electrical Association to release all information in regard to
this training to the electrical contractor/apprentice administrator listed above. This
waiver remains valid for my entire enrollment in the apprentice program.
Apprentice Signature: ______________________________________________________
Date: ___________________________________________________________________
I DO NOT wish to release information (sign below)
Apprentice Signature: ______________________________________________________
Date:
______________________________________________________________
Please return this Release of Grades Waiver with your registration form:
Email: info@electricalassociation.com • Fax: 612-827-0920
STUDENT WAIVER
FOR RELEASE OF GRADES
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2021-2022 EXTENDED APPRENTICE TRAINING (Electrical Association)

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Completed 17 July 2021

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