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ASE Certification Tests Prep Classes Registration Form
Name: __________________________________ Date of Birth: ____________________
Phone Number: Home: ______________________ Cellphone: _____________________
Email Address (print please): ____________________________________
Address______________________________ City_________________ Zip Code_________
Cerritos College Student ☐
Student ID#:________________________
Current Instructor(s):
____________________________________
Non-Cerritos College -Student ☐
____________________________________
Employer Information
(Automotive Related Only)
Company Name: _________________ Service Manager Name: ___________________
Company Phone #:________________ Service Manager # (Ext.): __________________
Company Address: ____________________________________________________________
City: ____________________________ Zip Code: _______________
Class(es) requested:
_____________________________________________________________________________________
_____________________________________________________________________________________