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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