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Rock Seconding School Registration
Name___________________________________________
Address_________________________________________
City____________________________________State_____
Zip_____________ CMC Member #___________________
Phone (evening)_______________ (day)_______________
Email:___________________________________________
Birthdate: ____________ BRCS Graduate: q Yes q No
Equivalent Experience: q Yes
Payment Method: q Check q VISA q MasterCard
Card # ________________________________________
Exp. Date____/____/____
Signature ______________________________________
Registration: fax (303-279-9690),
phone (303-279-3080, ext. 2), or in person.
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