PEAK Emergency Response Training > REGISTER 2018

NUEC 3 REGISTRATION (Step 2 of 7): SUBMIT PERSONAL DATA

For all Client courses please refer to your registration email for the course number and choose from below:

Course Number

Enter the course number (e.g. NUEC-3-????) of the course that you are registering for. The course number can be found on the course calendar.

Employer Funded Training Program

If your employer is funding this training program please indicate yes by checking the box.

Yes

If Employer Funded - Specify Name of Employer

If an employer is funding the training program, please provide the name of the employer.

First Name

Enter your first name.

Last Name

Enter your last name.

Address

Enter the address of where you reside.

City

Enter the city in which you reside.

Province/State

Enter the province or state in which you reside.

Country

Enter the country in which you reside.

Postal/ZipCode

Enter your postal or zip code of where you reside.

Cell

Enter your cell phone number in this format: (555) 555-5555.

Email

Enter your email address.

Date of Birth (dd/mm/yy)

Enter your date of birth in this format: dd/mm/yy.