L2 Electrofusion Training Registration

Name*
First Last
Email*
Phone*
Student City*
Student Postal Code*
Company Name*
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Training Requested*
- First Time L2 Certification
- L2 Re-Certification
Company Trained and Certified By*
Current Certification # (if applicable)
Years of Electrofusion Installation Experience*
- 0-1 year
- 2-4 years
- 5-10 years
- 11+ years
Size Range Currently Certified to Install*
Largest Diameter Electrofusion Coupler Installed*
Number of Couplers Installed (14"-24")*
Number of Couplers Installed (24" and Larger)*
Payment Options*
- Credit Card
- Company Purchase Order
Payment will be required after registration status has been confirmed. Pease indicate which method of payment will be used to finalize course registration requirements.

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