Plumbing Heating Cooling Contractors Association
Maryland Plumbing-Heating-Cooling Contractors, Inc. Suite 205, 10176 Baltimore National Pike, Ellicott City, MD 21042 (410) 461-5977
(410) 750-2507 fax
REGISTRATION FEES: $ 150. MARYLAND PHCC MEMBER ~ $ 225. NON-MEMBER
BACKFLOW RE-CERTIFICATION COURSE – APPLICATION ACCEPTED & APPROVED FOR CERTIFICATION IN THE STATE OF MARYLAND, W.S.S.C. & THE COMMONWEALTH OF VIRGINIA June 9, 2012 – Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD June 23, 2012 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD July 14, 2012 – Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD July 28, 2012 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD August 11, 2012 – Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD August 25, 2012 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD September 8, 2012 – Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD September 22, 2012 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD October 13, 2012 – Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD October 27, 2012 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD November 10, 2012 – Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD November 17, 2012 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD December 9, 2012 – Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD
SCHEDULE UPDATED EVERY 30 DAYS HOURS: 7:30 a.m. – 3:30 p.m.
A passing grade commensurate with National requirements on the final written examination and a satisfactory completion of the “Hands on” performance test will result in Certification. Certification is good for three (3) years. NOTE: Class schedules are updated approximately every 30 days. To reserve your space please be sure to register early. Class size is limited and applicants are accepted on a first-come first-serve basis. Name _____________________________________________________Home Phone (
) ___________________
Address_______________________________________________ Last 4 Digits of Social Security # ____________ City______________________________________________State__________Zip Code_______________________ Certification expiration date:__________________________________ School Attended: ____________________ Company Name________________________________ Phone (
) ________________ FAX (
)______________
Class Location request___________________________________ Class date requested_______________________ Signature of Applicant_____________________________________________________Date___________________
PAYMENT: Please make check payable to Maryland PHCC. Payment must accompany the completed application. Mail to: Maryland PHCC, Suite 205, 10176 Baltimore National Pike, Ellicott City, MD 21042. Enclosed is my check in the amount of $__________. CANCELLATION: What if I need to cancel? Applicants who cancel up to 10 days prior to the start of the course will forfeit 25% of the total fee to cover administrative fees. CANCELLATIONS LESS THAN SEVEN (7) DAYS PRIOR TO THE START OF CLASS WILL FORFEIT ALL FEES.