SAU Tech

AETA Registration Form

Class Information


Select program  


Date of Class  

Class  

Class Location  

Student Information


Last Name  

First Name  

Middle Initial


Student Identification Number
(Last 4 digits of SSN and first 3 letters of your last name)

Example: 1234ABC


Address  


City

State  

Zip  


Telephone

Fax

E-mail

Backflow Information

- (This section is only applicable to Backflow students)

AETA Tester Certification
(Does not apply to first time tester students)

Expiration Date


ATT #
(Does not apply to first time tester students)

Expiration Date

Employer Information


Employer  

PWS Number (if applicable)

Job Title


Address  


City  

State  

Zip  


Telephone  

Fax  

E-mail