PADEP Training Course – Recertification $250.00 each or Group of 3 or more discount rate 15% off. $50 discount for returning students. *If you must cancel your class after payment, a 3% cancellation fee will be deducted from the refund. Primary Company Contact InformationCompany/Individual Name*Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*FAXPrimary Contact Email Address* Enter Email Confirm Email Attendee InformationAttendee Information Name (as it appears on your certification card) Email Address PADEP Certification # Course Date Actions Edit Delete There are no Attendees. Add Attendee Maximum number of attendees reached. This field is hidden when viewing the formNumber of Attendees*PADEP Training Course - Recertification* Price: $0.00 PADEP Training Course - Recertification* Price: $0.00 Payment Information* - Only select the “Bill My Existing Keystone Account” payment option if you have an existing Keystone credit account. If you do not have an existing account, your registration may be delayed.I Would Like To Pay By*Pay OnlineBill My Existing Keystone AccountTotal: $0.00 Discount:Credit Card*Card Details Cardholder Name