Course Registration Form

*Course Location

Please select course location.

*Virtual Course Date (hold CTL to select multiple courses) Class Times: All 10:00AM - 6:30PM EST (7:00AM - 3:30PM PST)

You must select at least one option.

*Online Recertification Month (hold CTL to select multiple courses)

You must specify at least one option.

*Name of Student

Please enter the name of student.

*Job Title

Please enter job title.

*Country of Citizenship

Please select your country of citizenship.

*Your Company Name

Please enter your company name.

*Address

Please enter your address.

*City

Please enter your city.

*Province

Please select your province.

*Postal Code

Please enter a valid postal code.

*Phone Number

Please enter your phone number.

Fax No.

*Student Email Address
We will send class and exam download links to this email address. Students must have access on training/exam day.

*Manager / Office Email Address
This address will be copied on all correspondence.

Please enter a valid Email ID.

*Distributor (where you purchase product from)

Kidde Canada

Other

You must select a distributor.

Other

Please enter other distributor.

Purchase Order Number

PRE-ENGINEERED DISTRIBUTOR TRAINING Course Registration Form