Light/Medium-Duty
Towing Class
Student Registration
Form
(Click
here for printable copy)
Please complete the following information:
(PLEASE
PRINT)
Name As You Wish It To Appear on Certificate and
I.D.: _____________________________
Date of Birth: _________________
Experience in Towing ______Yrs. ______Mos.
Name of Towing Business
_______________________________________________
Business Mailing Address:
_________________________________________________
Home Mailing Address: __________________________
E-Mail Address: _________________________________
Do you hold any other certifications? Yes________ No _________
If yes, what company or association issued your
certification(s)
_________________________________
_________________________________
_________________________________
Cost: $ 150.00 if received by August 15, 2010
$ 195.00 if
received after August 15, 2010 or at the door.
Method of Payment: Cash Check Money Order
Make checks and money order out to: Tennessee Tow
Truck Association
Send
payment to: NATA
527
East Hillcrest Street
Altamonte
Springs, FL 32701
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