Display Fireworks Safety and Legal Awareness Course Registration

Please PRINT Clearly - Applicant fills out Sections A and B. Do not fill out Section C

A. APPLICANT INFORMATION

Family Name ______________________________

Given Name ______________________________

Date of Birth (yyyy/mm/dd) ___________

Mailing Address ______________________________

City ______________________________

Province/Territory _______________

Postal Code ________

Telephone ______________________________

Fax ______________________________

E-Mail ______________________________

Organization (if related to fireworks) ______________________________

Signature of Applicant ______________________________

Fireworks Operator Certificate: Display Assistant - may use display fireworks under the direct supervision of a Display Supervisor.
Other (i.e., already certified)
Authority Having Jurisdiction - members of the public services who are responsible for the authorization and support of pyrotechnics events, such as fire prevention officers, firefighters, and other members of agencies responsible for the carrying out of pyrotechnics events. A letter confirming the status of AHJ must be submitted with the registration form.

Course City: ___________________

Course Province/Territory: _________________________________

Date of Course (yyyy/mm/dd) _____________

Registration Requirements for the Display Fireworks Safety and Legal Awareness Course:

Fee is $150.00. Note: Fee is waived for those attending as Authority Having Jurisdiction only;
To register for Display Fireworks Safety and Legal Awareness Course, mail registration form, payment and one current photo to the ERD region where the course is being held. Please note:
Form F18-01 must be completed and signed;
Accepted methods of payment are certified cheque or money order only payable to Receiver General for Canada; and
Digital photos are now accepted. Email the photo to the email address in your region. Photos must be in JPEG format with your last name as the file name (i.e., Smith.jpg). Ensure your name, course location and date is in the subject line.

Canada: (excluding Quebec)
580 Booth Street, Ottawa (ON) K1A 0E4
Tel. (613) 948-5200, Fax. (613) 948-5195, Email: canmet-erd@nrcan.gc.ca

Quebec:
P.O. Box 100, 2050 Girouard West, Saint-Hyacinthe (QC) J2S 7B2
Tel. (450) 773-3431, Fax. (450) 773-6226, Email: EasternRegion@nrcan.gc.ca

FINANCE

Cheque or Money Order No.______ Fee Paid: $ ____ Reference no.______

PYRO ID:

Certificate No.: ________ Type: ______________ Expiry Date: ____________

Approved by: ______________________ Date: _____________