Regional Testing

PLEASE NOTE: All re-requisites, required courses and certifications must be successfully completed and certifications must have been issued prior to registration for an exam. All required documentation must be submitted with registration form or form will not be processed!

All exams will begin promptly at 9:00. **Please arrive 30 minutes prior to scheduled test time**

07/10/2013 9AM Charlotte FD Training Center Deadline 06/20/2013

07/17/2013 9AM Forsyth Tech CC Deadline 06/26/2013

07/29/20139AM Raleigh – OSFM Deadline 07/01/2013

08/20/2013 9AM Mitchell CC Deadline 07/25/2013

08/21/20139AM Raleigh – OSFM Deadline 07/21/2013

08/22/20139AM Raleigh – OSFM Deadline 07/22/2013

09/12/2013 9AM James Sprunt CC Deadline 08/25/2013

09/18/2013 9AM Rowan Cabarrus CC Deadline 08/29/2013

Please write the Exam code and complete exam title you are registering for below. Refer back to Regional testing website for this information.

Exam Code : ______

Exam Title: ______

(Example : Exam Code: Q102, Exam Title: Fire Fighter 1&2 Qualification)

Social Security Number(Last 4 digits) ______Date of birth ______/______/______

mm / dd / yyyy

Name: ______

LastFirstMiddle

Home Address:______

Street or Box City State Zip

Email: ______(This will be our first point of contact)

Phone: Home: ( _____ ) ______Business: (_____ ) ______

Fire/Rescue Agency ______

Signature ____________Date ______

REGISTRATION FORMS MUST BE POSTMARKED NO LATER THANTHE DEADLINES LISTED ABOVE.

FORMS RECEIVED AFTER THIS DATE WILL NOT BE PROCESSED You will receive information regarding your registration once forms have been processed.

Please mail or fax this form to: Brandi Maynard, Regional Testing Registration

1202 Mail Service Center Raleigh, NC 27699-1202 Fax: (919) 662-4670

Contact:

Regional Testing

PLEASE NOTE: All re-requisites, required courses and certifications must be successfully completed and certifications must have been issued prior to registration for an exam. All required documentation must be submitted with registration form or form will not be processed!

All exams will begin promptly at 9:00. **Please arrive 30 minutes prior to scheduled test time**

09/25/2013 9AM Raleigh – OSFM Deadline 09/01/ 2013

09/26/2013 9AM Raleigh – OSFM Deadline 09/01/ 2013

10/16/20139AM Skyland FD Deadline 09/29/2013

11/02/2013 9AM (SATURDAY) Durham FD Deadline 10/16/2013

11/06/2013 9AM Central Carolina CC Deadline 10/16/2013

11/20/20139AM Halifax CC Deadline 11/01/2013

12/04/2013 9AM ***Raleigh – OSFM Deadline 11/20/ 2013

12/05/2013 9AM ***Raleigh – OSFM Deadline 11/20/ 2013

***These are the last Regional tests of 2013

Please write the Exam code and complete exam title you are registering for below. Refer back to Regional testing website for this information.

Exam Code : ______

Exam Title: ______

(Example : Exam Code: Q102 Exam Title: Fire Fighter 1&2 Qualification)

Social Security Number(Last 4 digits) ______Date of birth ______/______/______

mm / dd / yyyy

Name: ______

LastFirstMiddle

Home Address:______

Street or Box City State Zip

Email: ______(This will be our first point of contact)

Phone: Home: ( _____ ) ______Business: (_____ ) ______

Fire/Rescue Agency ______

Signature ____________Date ______

REGISTRATION FORMS MUST BE POSTMARKED NO LATER THANTHE DEADLINES LISTED ABOVE.

FORMS RECEIVED AFTER THIS DATE WILL NOT BE PROCESSED You will receive information regarding your registration once forms have been processed.

Please mail or fax this form to: Brandi Maynard, Regional Testing Registration

1202 Mail Service Center Raleigh, NC 27699-1202 Fax: (919) 662-4670

Contact: