Application for Rescue 3 Training

APPLICATION
FOR
RESCUE 3 TRAINING

Complete the following form or print it out and mail it with your check to:

Wimberley Fire Department
Attn: Rescue Training
P.O. Box 675
Wimberley, Tx 78676

Address:

For more information contact:

Lynn Burttschell or Carroll Czichos at (512) 847-3536 or by email: Training at Wimberleyfire.com

***One-half of the tuition, as a deposit, is required to be mailed 14 days prior to class date***

Name:

City:

State:

Zip:

Department Name:

Phone Numbers:

Email:

Class Type:

Class Date:

Tuition:

New Student:

Recert: