NGICP Train-the-Trainer Registration

One Time Credit Card Payment Authorization Form

By completing and submitting this form, you authorize Water Environment Federation to charge your credit card for the amount listed below. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account.

Please complete the information below:

Training City: *
Date/Location: *

First Name*

Last Name*

Organization

Address*

City*

State*

ZIP*

Phone 1 (Mobile)*

Phone 2 (Mobile)

Email*

Trainer Qualifications

All NGICP approved trainers must possess two of the following three qualifications:

Minimum of a bachelor of science degree in water resource management or environmental science
Minimum 35 hours of experience as a trainer for hands-on, adult learning courses
Direct experience in Stormwater Green Infrastructure(GI) construction, inspection, or maintenance

Please submit Qualified Trainer Application to acaldarelli@wef.org, along with proof of meeting two of the three trainer qualifications (listed above).

ADA Accommodations

Do you have an ADA Title I disability/impairment for which you may need assistance during the training?
Yes
No
Please send a letter to NGICP@WEF.ORG (from a medical professional authorized to make such assessments) that describes the specific accommodations that will be required.

Please type your FULL NAME and DATE:
*

I authorize Water Environment Federation to charge the amount listed below.

The cost of this training is $1500. This gives you access to the course material and training curriculum.

PLEASE NOTE: In order to provide the training to your audience, a training license must be purchased from the Water Environment Federation. Trainers who do not wish to purchase a training license, may only train for an organization that has a valid NGICP license. The cost of the training license is $7500 and due prior to any training offered by you. Please contact ngicp@wef.org if you are interested in acquiring a training license.

Amount*: $

Account Type*: AMEX MasterCard Visa

Cardholder Name*:

Card Number*:

Expiration Date*:

CVV*:

My above Address is my Billing Address
Billing Address*: Phone*:

City*: State*: ZIP*:
Email*:

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. Receipt of payment will be sent to the listed email address, unless otherwise specified.
I certify that my answers are true and complete to the best of my knowledge.

If you have questions regarding your payment, please contact:

Accounts Receivable

703.684.2427 - Phone
703.684.2428 - Fax
payments@wef.org