EmailMeForm
CASI Student Sign up Form (Nova Scotia)
Use this form to sign up for CASI ATV Safety Training
Todays Date
*
MM
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DD
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YYYY
Recommended By
Please use this field if you are an Instructor signing up a student who contacted you directly, or if you are a student who was asked by an Instructor to fill out this form. This assures that student and instructor will be paired together for the training course.
Name
*
First
MI
Last
Date of Birth
*
MM
/
DD
/
YYYY
Eye Colour
*
Please select
Blue
Brown
Hazel
Green
Amber
Black
Other
Email
Confirm
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Work / Home Phone
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Cell Phone
*
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Availability
*
Weekdays during normal business hours
Weekends only
My schedule is flexible
Specific days and or times
I would be available to take the training....
Check all that apply
Other Information
*
I own an ATV and am able to use it to take the training
I have already passed an ATV Course
I do not require re-certification
I require re-certification every?
Check all that apply