Submit Online Please complete a registration form for each student and hit the "submit" button. Note: If you are not the person who is actually taking the course PLEASE make sure that those attending understand the requirements stated below. EVERY student must demonstrate a working knowledge of backflow prevention and testing in order to pass this course,therefore it is imperative to review the materials sent to you before attending class in order to have a basic understanding of the material that will be presented. If you are not prepared and it is deemed that you do not understand the concepts of backflow prevention and testing you may be sent home without a refund. Take advantage of the information contained in this website. If paying by credit card (Discover, MasterCard, Visa, American Express) call Steve (585) 216 - 2223 after submitting form. Please note that certificates will be issued 6 - 8 weeks after Course Completion. Please plan accordingly. Please supply a good email address below for business and student. You will be receiving emails with important class information and reminders. Company Business Phone Company Address City State Zip Business Email Student Name Phone Home Address City State Zip County of Residence Email NYS Cert# (if recertifying) Expiration Date CCCF Course Testing Dates - Check only One (one is required - either Initial or Recertification) Initial Class $750: Sept 9 - 12 Now FullOct 21 - 24Dec 9 - 122025 Classes:Jan 13 - 16June 2 - 5June 23 - 26Aug 18 - 21Dec 15 - 18 Recertification $275: Sept 6Sept 13Oct 18Oct 25Dec 062025 Classes:Jan 10Jan 17May 30June 6June 20June 27Aug 15Aug 22Dec 19 Payment Type: Credit CardCheckPO Payable to: Cross Connection Control Foundation with the amount $ Number of registrations If paying by credit card (Discover, MasterCard, Visa, American Express) call Steve (585) 216 - 2223 after submitting this form. You will receive a receipt/confirmation via email to the company email provided above. Mail Checks or POs to: CROSS CONNECTION CONTROL FOUNDATION, 255 Basket Rd. webster, NY 14580 Proper Id required before entry to class. Δ