APS Registration Form APS Registration Form Click here to print this form, complete, and mail in with your payment. Student First Name * Student Last Name * Company Name * Shipping Address * City State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Phone * (###) ###-#### Fax * (###) ###-#### Student Email * Select Your Courses (all courses DOT unless specified): BAT* with Device Training/Mock Tests (new or refresher) EBT Make/Model: $470.00 BAT* with Device Training/Mock Tests & Instructor Training (new or refresher) EBT Make/Model: $1365.00 Collector (Urine) with Device Training/Mock Tests (new or refresher) $315.00 Collector (Urine) with Mock Tests & Instructor Training (new or refresher) $505.00 Collector (Alternate Technologies) with Mock Tests - Non-DOT Collection Type/Device $225.00 Designated Employer Representative DER Training $350.00 Error Correction BAT STT Collector Must submit error correction paperwork with registration $100.00 STT with Device Training/Mock Tests (new or refresher) ASD Make/Model: $315.00 STT with Device Training/Mock Tests & Instructor Training (new or refresher) ASD Make/Model: $505.00 Supervisor Reasonable Suspicion Training $100.00 Click here to print this form and mail in with your payment. **PRICES EFFECTIVE 01/01/18 & SUBJECT TO CHANGE** SUB-TOTAL: Additional charges for multiple and international locations. SHIPPING/HANDLING: $15.00 FINAL TOTAL: DATE DESIRED: Schedule location on APS website CLASS OPTIONS Webcam Classroom PAYMENT REQUIRED IN ADVANCE. APS WILL CONTACT YOU FOR YOUR BILLING INFORMATION All cancellations subject to a $100.00 fee once confirmed by APS. *Includes additional Calibration Technician Training for Lifeloc devices only. Student Initials * All APS courses require the student to complete the corresponding Online Course as a pre-requisite (included in the course price). The Online Course must be passed with a score of 85% or better at least 3 days prior to the scheduled class date. Additionally, the student is responsible for having the necessary supplies available for class. All supplies are listed on the APS website and detailed on the Course Confirmation Letter emailed to the student. Student Initials * Full payment is required at the time of registration. A $100 rescheduling fee will apply for any changes required after a class date has been confirmed. This includes, but is not limited to, rescheduling due to technical issues, non-completion of the course pre-requisites, and not having the required supplies available for class. Cancellations made 14 days or more prior to the confirmed class date will be assessed a $100 cancellation fee, with the balance issued as an APS credit for future purchases. No credit will be given for cancellations made less than 14 days prior to the scheduled class. If you are human, leave this field blank. Submit