Minnesota State Fire School Duluth - Registration Form

* Denotes a REQUIRED field

Department Information
Department Name*
Street Address*
City*
Zip Code*
Station Phone*
Station Fax
Chief's Name
Contact Information
Contact Person*
Rank
Day Phone
Night Phone
Email Address*
Billing Address (if different than Department Address)
Street
City
Zip Code
Method of Payment (select one)*
I Will Bring Payment
Bill My Department or Agency
I Am Attending and Paying Personally
Student Information
Students First Name*
Students Last Name*
Street Address* - MUST be the STUDENTS address for transcript purposes!
City*
Zip Code*
Birthday* - This is required for transcript purposes.
Course Selection: Select one course for a first choice and one course for a second choice. Confirmation will be sent to the fire department so please check with your department.
First Choice: #601 Basic Auto - X #600 Advanced Auto - X #1205 Basic Rope Rescue #1618 Intro to Water Rescue #Advanced Wilderness Search Concepts #303 Basic Fire Pump Operation
Second Choice:> #601 Basic Auto - X #600 Advanced Auto - X #1205 Basic Rope Rescue #1618 Intro to Water Rescue #1221 Advanced Wilderness Search Concepts #303 Basic Fire Pump Operation