DOD On-Line Registration

Date Which location are you attending? Choose one Grissom ARB Ft. Huachuca Hill AFB Vance AFB NSA Crane Bangor ANG Other specify in comment box U.S. Citizen? Yes No

Last, First, MI SSN#  Duty Station

Home Address Apt CityStateZip

Home Tel#Work Tel#ExtCell#

Overseas Calling CodeCountry    Email address

If you entered an overseas address above, in the comment box, list a stateside contact persons name, stateside address, tel #  and relationship. (note:  individuals will not be contacted unless we are unable to make contact with you for any reason.

Billing Information

Authorized Billing (FD/Organization/Unit, etc.)

Name, rank  and/or title of the individual who authorized this payment

Tel # of individual who authorized payment Ext Other 

Authorized Billing Address

CityStateZip

Payment Type Choose One Visa MasterCard Purchase Order Mailing in Payment Specify Other Call in credit card info/under construction

Check the course (s) you are registering for and add the dates in the box next to the course.

Fire Officer I                                             Fire Instructor I                                                                                                        

Fire Officer II                                         Fire Instructor II/III

Fire Officer III                                      Fire Inspector I/II 

NOTICE TO ALL REGISTERED STUDENTS

By completing this registration you are responsible for payment and any cancellation fee that may apply.  You are also agreeing that the information completed is true and accurate.  If your department/organization or other entity  does not make payment  on or before the due date set forth on the invoice or by the IFIA, you will be responsible for payment.  Please make sure you are approved by the listed authorizing agency/organization.  All information must be completed entirely on this registration form.  If you have any questions please feel free to contact the office.  800-235-0282 or email us at ifia@insightbb.com. 

All cancellations must be done 30 days prior to the start of the course date.  If you cancel after the 30 days you will be responsible for a $50.00 processing fee.

Release: 

I, the registered student listed on this registration form, hereby grant the Indiana Fire Instructors Association to receive the following information; current address, current telephone number, current base/duty assignment, and/or any other information that they (the IFIA) feels appropriate in locating my whereabouts in the event I fail to make payment for the services that were rendered.  

I the above registered student agree to this release. 

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