Phoenix Safety & Associates, LLC
Scott K. Pomarico,Sr.
P.O. Box 82
Hasbrouck Heights, NJ 07604
201-288-0264 Phone
theelectricmedic@gmail.com
Registration Form
Prep Course for NJ Electrical Contractors License
Name: _____________________________________________________NJ ELEC LIC #_________________________________
Address: ____________________________________________________
City________________________ State_______ Zip Code_____________
Home #:_________________ Cell #:__________________E-Mail: _________________
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TOTAL PAYMENT ENCLOSED $__________
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All cancellations must be in writing and received 5 Days prior to seminar. Registrant is liable for total cost. Two forms of ID required at all seminars. Phoned reservations do not guarantee a seat. Seat guaranteed by pre-payment only. Please make checks payable to
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CALL DINA TODAY IF YOU HAVE ANY QUESTIONS 201-288-0264
