Wildfire Academy On-line Registration

If you have any difficulty filling out the online registration, please contact Deb Jacobson at 218-749-7731 or deb.jacobson@advancedmn.org.

First Name (required)

Middle Initial (required)

Last Name (required)

Last 4 of SSN (optional)

Student Primary Phone Number (required)

Alternate Phone Number

Student Email

Emergency Contact Name

Emergency Contact Phone Number

Organization/Agency/RFD (required)

SEND COURSE CONFIRMATION TO

Name (required)

Mailing Address (required)

City (required)

State (required)

Or Province

Zip Code (required)

COURSE SELECTION AND FEES

MNICS Agencies will be given a preference registering until April 22th. All registrations must be received by May 16th, 2016 to avoid any late fees.

LATE FEE IF AFTER MAY 16TH $50
S130/S190/L180 Basic Wildland Firefighter $205
S131 Advanced Firefighter #1 $50
S131 Advanced Firefighter #2 $50
S133 Look Up, Look Down, Look Around #1 $35
S133 Look Up, Look Down, Look Around #2 $35
S200 Initial Attack Incident Commander $90
S211 Pumps $165
S212 Wildfire Powersaws $165
S212 Refresh Chainsaw Recertification $20
S215 Wildland Operations in the Urban Interface $165
S219 Firing Operations $125
S230 Crew Boss $125
S231 Engine Boss $90
S236 Heavy Equipment Boss $165
S261 Applied Interagency Incident Business Management $130
S270 Basic Air Operations $90
S271 Helicopter Crew Member $205
S290 Intermediate Fire Behavior $165
S290 #2 Intermediate Fire Behavior $165
S330 Strike Team/Task Force Leader
ICS300 Intermediate ICS $125
ICS400 Advanced ICS $120
RT130 Annual Fire Safety Refresher $35
L280 Followership to Leadership $90
D310 Support Dispatcher $205
FI110 #1 Wildland Fire Obs & Origin for FR's
FI110 #2 Wildland Fire Obs & Origin for FR's
EVOC #1 $80
EVOC #2 $80
RX341 Prescribed Fire Plan Preparation $205
IWIM #1 Incident Within an Incident Management $195
IWIM #2 Incident Within an Incident Management $195

DORMITORY HOUSING OPTION

80 beds are available at Itasca Community College on a first come, first serve basis. The cost is $19/day. Single, double and triple dorm rooms are available.

Students must supply their own bedding, and tobacco products and alcohol are prohibited in the dormitory

I am interested in dormitory housing (required)
Yes
No - Please continue down to Payment Method

Dormitory Occupancy Preference

My Gender
Male
Female

I have a roommate preference - Please list name below

Evening I need dormitory lodging - Please check all that apply
Sunday
Monday
Tuesday
Wednesday
Thursday

NOTE: There will be a $20 charge for dormitory no-shows. Students must cancel room reservations by Friday, May 22nd to avoid this charge.

PAYMENT METHOD

Please check all that apply
Check - Payable to Advanced Minnesota
Credit Card - Please call with Credit Card information
Volunteer Firefighter Assistance Grant - Please see further information below
Purchase Order or Letter of Billing Authorization

Please fax: 218-749-7782
or mail to: Advanced Minnesota Fire Training Program
1001 West Chestnut Street
Virginia, MN 55792

THIRD PARTY BILLING INFORMATION

If you are paying via Purchase Order or Letter of Billing Authorization, please enter the third-party billing information below.

Billing Contact Name

Billing Mailing Address

City

State

Or Province

Zip Code

Billing Contact Phone Number

VOLUNTEER FIRE ASSISTANCE GRANT

If you are a member of a Minnesota Fire Department, AND your are NOT employed by a wildland fire agency, do not send tuition payment. Tuition will be paid directly to the college through a grant. (Dormitory Housing and no-shows are the responsibility of the individual and/or fire deparment)

Please fill out ONLY if you are paying for tuition via the Volunteer Fire Assistance Grant

Student's Fire Department Affiliation

Fire Chief's Name

Fire Chief's Contact Number

I AGREE TO THE TERMS AND CONDITIONS LISTED BELOW

BILLING REQUIREMENTS

Individuals not affiliated with any agency must remit payment prior to the deadline.  Department/Agencies may be billed for fees if the registration is followed up by a purchase order or authorization letter signed by an agency administrator on official letterhead with the appropriate billing address.

Billing of all registered participants will be done regardless of attendance.

Cancellation Policy

Cancellations must be made in writing for consideration of any reimbursement or credit.  No refunds will be made after June 3, 2016.

Class Confirmation

Class confirmation will be mailed at least two weeks prior to the start of the academy.  If you have not received class information by then, please contact 218-749-7731.

ADDITIONAL REQUIREMENTS

Participants must submit official proof of pre-requisites with their registration form pertinent to the class you are enrolling for.  Copies of incident Qualification System (IQS) or Incident Qualification and Certification System (IQCS) records will meet this requirement.  Registrations will not be processed without this documentation.

You may fax or mail your pre-requisite information to the phone number or address listed below.

Advanced Minnesota Fire Training Program

1100 Industrial Park Drive

Eveleth, MN 55734

Fax: 218-744-7511

Phone: 218-749-7731

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