As you are aware all backflow prevention devices must pass a mechanical test. In order to become a Certified Tester with the Indiana Department of Environmental Management certain criteria must be met. Please note class location preference below.

FORMAT: ONE WEEK CLASSES will be held Monday through Friday, 8 a.m. to 4 p.m. local time with 1/2 hour for lunch. Final examination will be held on Saturday

CLASS FEES: $500.00 Payable to Ind. Chapter, ABPA, includes Chapter Membership and National, ABPA 1 year membership.

NEED: Each student must furnish the following: one 6” or 8” crescent wrench, one 6” or 8” flat-bladed screwdriver and note taking materials. All devices, test kits, and hook-up material will be furnished.

CLASS INFO: Acceptance in class in order of date of receipt of checks & applications. Each applicant will be notified of the class date, location, and format as their application and checks are received. You will be notified later of date & location. These classes will be limited!

CANCELLATION:  If you need to cancel: Deadline is 10 days prior to first date of class after which NO REFUNDS WILL BE GIVEN.

Each class is subject to cancellation by the Indiana Chapter, ABPA in the event there is an insufficient enrollment number.

Substitution: A student substitution may be made up until Thursday noon before class begins by notifying chapter office.

Tuition and Membership: Checks will be held until the applicant accepts the class offered then banked. should an applicant wish to withdraw his/her registration and payment in a timely fashion both will be returned by making written request and furnishing a self-addressed stamped envelope.

YOUR CONFIRMATION: IMPORTANT! Please reply immediately by fax or telephone when you receive notification of class date & location whether you plan to attend or decline. Failure to do so may result in cancellation!

Please fill out and fax or mail the bottom portion of this form to:

Indiana Chapter, American Backflow prevention Assn.- TESTER CLASS REGISTRATION

Name_________________________________________________________________________________

Address (Res): ____________________________________________ Telephone: ___________________

Company: ________________________________________________ Telephone: ___________________

Address: __________________________________________________ Fax: ____________________

Total Amount Due: $500.00 Payable ton Ind. Chapter, ABPA. (Tuition, State Membership and National ABPA 1 year membership)

Quesitons: ABPA, Indiana Chapter Office

2695 Airport Road Centerville, IN 47330 Total Enclosed: $______________

Office: 765-935-3561 Fax: 765-965-1884