REGISTRATION FORM Provider Approval # 0042 Home Builders Association of Northeastern North Carolina PO Box 59, Aydlett, NC 27916 252-453-6668 Email: hbaofnenc@gmail.com
PAYMENT INFORMATION Check Enclosed Visa/MC CC # __________________________________ Exp. Date: _____/_____ CVV Code: _____ Print Name: _____________________________________ Amt. Authorized: _________ Billing Address for card: _____________________________________________________ Signature: ___________________________________________________________________
To complete registration, you will need to list your name and qualifier number as it appears on the North Carolina Licensing Board for General Contractors website, https://nclbgc.org/qualifier-search/. In accordance with NCLBGC: This class requires an identification check; NCBI requires registrants to present a picture ID (valid state or federal ID preferred) at check-in. Registrants are required to be present for the entire duration of the course to receive NCLBGC Continuing Education Credit. First Name: ________________________________________ Last Name: _________________________________ Company: _______________________________________________________________________________________ Billing Address: ________________________________ City: ____________________ State: _____ Zip: _______ Phone: ( ) __________________ Email: ___________________________(Email required to receive CE Certificate) Local HBA: #3454 HBA Member# _________________ NCLBGC Qualifier# ________________________ (if applicable) (if applicable)
CANCELLATION POLICY Course registrations will not be confirmed unitl registration is complete and payment/billing information is received in full. Cancellation requests must be received no later than June 5th in order to receive a full refund of paid registration fees. No-shows and cancellations not made within the specified cancellation period will incur the full cost of registration .
SELECT COURSES
NCHBA Member Rate
PM107 Building Codes
$95.00
BT111 NC Residential Energy Code Chapter 11 Changes
$47.50
M2020 Mandatory CE Course
$60.00
Tuesday, 6/16 3:30 pm
2 hr.
Non-Member Rate
DATE/START TIME
LENGTH
$120.00
Tuesday, 6/16 8:00 am
4 hr.
Tuesday, 6/16 1:15 pm
Registration Total: $ ___________________
Continuing Education Classes - COA in Elizabeth City (FC-121-A)
All card transactions will incur a 2.5% convenience fee. Please make checks Payable to HBA of NENC.