Credential/Certification Enrollment Application

Credentials/Certifications Enrollment Form
First Name*
Last Name*
Date*

MonthDayYear
Date
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone No.
Cell No.*
Emergency Contact*
Telephone*
Are you at least 18 years old? (select from drop down menu):*
Are you a current or former Enzweiler Building Institute Student?*
Employer*
Is your employer a member of the Building Industry Association?*
I am registering for the following industry credential/certification (select all that apply):
Scissor Lift Operator Certification

Date: Tuesday, March 24, 2026

Time: 6:00pm to 9:00pm

Location: EBI Erlanger Campus (2751 Circleport Drive)

Cost: $150 DUE AT THE TIME OF REGISTRATION

Skid Steer (Bobcats) Operator Certification

Date: Wednesday, March 25, 2026

Time: 6:00pm to 9:00pm

Location: EBI Erlanger Campus (2751 Circleport Drive)

Cost: $150.00 DUE AT THE TIME OF REGISTRATION

Compact Excavator (Mini Excavator) Operator Certiication

Date: Thursday, March 26, 2026

Time: 6:00pm to 9:00pm

Location: EBI Erlanger Campus (2751 Circleport Drive)

Cost: $150.00 DUE AT THE TIME OF REGISTRATION

YOU MUST BE AT LEAST 18 YEARS OLD TO REGISTER FOR CLASS!
Please select all seminars you are registering for:*

Scissor Lift (3/24/26) $150.00Skid Steer (3/25/26) $150.00Compact Excavator (3/26/26) $150.00
Agreement: Please carefully read and indicate your acceptance by confirming each item:
I understand I need to pay for each class in full at the time of registration.*

I understand
I understand that at least 10 students need to register for the class to take place.*

I understand
I understand if the class is cancelled due to lack of registration, I will receive a full refund.*

I understand
I understand that assume all liability while participating in the class.*

I understand
Student Full Legal Name*
Date*

MonthDayYear
Date
Signature*

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Registration Fee*

Registration Fee

$150.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Credentials/Certifications Enrollment Form

I am registering for the following industry credential/certification (select all that apply):