Electrofishing Principles and Safety Certification Course Sign-up

Use this form to register for the Electrofishing Principles and Safety Certification course hosted and taught by Smith-Root.

Course participants are expected to provide the following:

• Lineman gloves
• Non-breathable chest waders and associated footwear
• Note taking materials
• Optional: polarized sunglasses and rain gear

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Your Information

Name

Organization

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Telephone

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Course Attendance Date

Course Date

Payment Information

The class at our Vancouver headquarters costs $500 per student or is included at no cost with the purchase of any new Smith-Root backpack electrofisher. Courses held at other locations will have different costs.

Payment Options

Credit Card

Course Voucher

Purchase Order

Purchase Order Number

Additional Information

These questions are optional, but your answers will assist us in planning a course that meets your needs.

What prompted you to seek training?

What do you hope to learn from the course?

What electrofishing equipment (i.e. make and model) do you generally use?

By submitting this form, participant certifies that the information provided herein is true and accurate and that they have read and agree to the terms and conditions provided in the Electrofishing Course Agreement and Liability Release. Participants are also required to sign the Liability Release on day of class.

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