Fire Logistics Training 
Nomination Form	
	Part I:  Registration	
Course Name:	   For Company Training Representative use:	
	Priority  ___ of ____	
Course Dates:	Course Location: 	Course Tuition: 	
	  	   Nominations Due by: 	
Course Coordinator:
Bruce Suenram	Coordinator Phone: (Voice/Fax)
406-449-9761/406-449-9768             	Coordinator E-Mail:
training@firelogistics.com	
Nominee's Name:	Date Submitted:	
		
  Working Job Title:
	E-mail Address: 
Fax Number:       	
Billing/Sponsoring Company (Name, Address):	Nominee's Mailing Address (if different) 	

		
Telephone:		Telephone:		
List training completed and dates pertinent to this course:	
	
List your past qualifications pertinent to this course: 	
	
Nominee's Signature: (I will notify the Coursc Coordinator if I am unable to attend.)

Supervisor's Signature: (I certify the nominee meets the prerequisites, or if not met, I will put the reasons for attending the course in Remarks.)	
	
 Remarks:	
	
Part II:  Financial
Send this completed nomination form with a check made payable to Fire Logistics, Inc.to:
 	
	Fire Logistics, Inc.
	PMB 2164
	1 Jackson Creek Road
	Montana City, MT 59634-2164 

For questions regarding the registration process or course information, contact the course coordinator, Bruce Suenram (see above).

Authorizing Signature:							Date: