LSU Carrol L.
Herring
Fire & Emergency Training
Institute
COURSE REGISTRATION FORM
(Revised January 7, 2020
)
Please complete one form for each student for each class and forward it, along with a check, money order,
credit/debit card contact information, or purchase order (hard copy) with a valid billing address to FETI.
Individuals will be notified via e-mail upon review of their application.
Charges are non-refundable unless cancellation is confirmed in writing at least two weeks prior to the starting
date of the class. Individuals not sponsored by a fire department must pay all charges in advance. Charges are
refundable in full if FETI cancels the class.
Course Title
Date Offered
Name First Middle Last
Fire Department/Company/Individual
Chief/Training Officer (if applicable)
Fire Department/Company/Individual Mailing Address or Home Address
C
ity State Zip
Telephone (w) (H) (Fax)
Student E-Mail Address
Chief/Training Officer E-Mail Address
METHOD OF PAYMENT
Check/Money Order (Payable to LSU)
Incumbent Worker Training Program Grant
Billing Auth./PO# ______________________
* If paying by PO, a physical copy of the PO must Requesting Disability Info
Yes
No
be sent in with the registration form. * Email must be provided above
Credit/Debit Card Veterans Affairs Student
Yes
No
* VA Students must submit transcripts of all prior training
and/or education received.
* For security purposes, we will contact you via
phone to obtain card information. Please
provide the following contact information:
Contact Name: ___
Contact Phone Number: ____________________
_________________________
Please return form to:
Fire and Emergency Training Institute
6868 Nicholson Dr
Baton Rouge, LA 70820
Telephone: 225-334-6300, 800-256-3473
FAX: 225-334-6341
EMAIL: cmullenix1@lsu.edu
