Maryland Plumbing-Heating-Cooling Contractors, Inc. 10176 Baltimore National Pike, Suite 205 Ellicott City, MD 21042-3652 (410) 461-5977 fax (410) 750-2507 e-mail: phccmd@aol.com
REGISTRATION FEES: $ 150. MARYLAND PHCC MEMBER ~ $ 250. NON-MEMBER
BACKFLOW RE-CERTIFICATION COURSE – APPLICATION ACCEPTED & APPROVED FOR CERTIFICATION IN THE STATE OF MARYLAND, W.S.S.C. & THE COMMONWEALTH OF VIRGINIA January 9, 2016 - Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD January 23, 2016 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD February 6, 2016 - Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD February 20, 2016 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD March 5, 2016 - Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD March 19, 2016 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD April 9, 2016 - Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD April 23, 2016 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD May 14, 2016 - Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD May 21, 2016 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD June 11, 2016 - Thos. Somerville Co. – 1510 Tilco Drive – Frederick, MD June 25, 2016 – Dundalk Community College – 7200 Sollers Point Road – Dundalk, MD
FOR SCHEDULE UPDATES CONTACT THE OFFICE (410) 461-5977 HOURS: Starting time for this course 7:30 a.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 ______
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Address_______________________________________________ Last 4 Digits of Social Security # _____________ City______________________________________________State__________Zip Code________________________ Certification expiration date:__________________________________ School Attended: _____________________ Company Name______________________________________ (
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Class Location request___________________________________ Class date requested _______________________ Signature of Applicant_____________________________________________________Date____________________
PAYMENT: Payment must accompany the completed application. Please make check payable to Maryland PHCC and 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.