National Ski Patrol
Outdoor Emergency Care Course Order Form
(For Instructor Use Only)
Fax: 303-988-3005 Phone: 303-988-1111 Email: education@
Mail: National Ski Patrol, 133 South Van Gordon, Suite 100, Lakewood, CO 80228
Instructor of Record
Member ID # Course Number
Daytime Phone Number
E-mail address
Billing Information
Invoice Name Member ID #
Invoice Address
City State Zip Country
Form of Payment (Please select your method of payment):
On Consignment (A backup credit card number or ski area PO number must be provided)
Charge total amount to my VISA MasterCard Discover Amex
Account Number Expiration Date
CSV (CSV code is located on the back of credit card to the far right, Amex is located on front of credit card)
Signature
Purchase order number Name of Ski Area
Full payment enclosed, check or money order payable to the National Ski Patrol.
No cash or C.O.D.'s please
Ship to: (if different from billing information)
Name Member ID #
FedEx Shipping Address
City State Zip Country
OEC Course Materials Unit Price Quantity Total
OEC Course Test Fee (includes written and practical exam, certificate, and answer sheet)
OECM OEC Course Test Fee-NSP Member 60.00 # $
OECAA OEC Course Test Fee -Affiliate/Associate 80.00 # $
OECNM OEC Course Test Fee-Non-Member 300.00 # $
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#501 Ski Patroller’s Manual 12.00 # $
Sub Total $
Ground Shipping determined by weight.
Please enter X in choice of shipping Standard Ground $
2nd Day Air $
Overnight $
Shipping Charges based on weight for total number of books.
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