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Pillarella School of
Electrical Code & Theory |
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Registration Form Fill out Your Name Exactly As It Appears On Your License. Name:_______________________________________________________ Address:_____________________________________________________ City:______________________State:__________ Zip:______________ Phone:_____________________________________________________ Email:_______________________________________________________ Mass. License #'s _Masters______________________Journeyman_______________________ Out of State Lic. #'s : RI________________NH________________VT______________ME___________ IAEI Member:_________Meca Member:_______ Retired:______ Date of Course:___________________________________________ Please fill out the above form and mail with a $50.00 check or money order deposit payable to: P.S.E.C.T. PO Box 371 Assonet, Ma 02702-0371 Out of State Licenses Add $10 Administration Fee (Returned / Bad Check Fee: $35 Charge)
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