NAME:________________________________________
NUMBER___________
ADDRESS________________________________________________________
________________________________________________________________
CITY___________________________________
STATE________ ZIP________
COUNTRY_______________________________________________________
PHONE __________________________ FAX
__________________________
E-MAIL
__________________________________________________________
I have attended a total of _________
manufacturer’s seminars and workshops.
I have attained a level of proficiency that combined with my years of experience qualifies me for recognition as: (please check all that apply)
( ) new $35
( ) renewal $25
( ) Cylinder Inspector Agency____________________________#_____
( ) Repair Technician
( ) Senior Technician 8 yrs. Minimum 6 seminars by 3 manufacturers.
( ) Master Technician 18 yrs. Minimum 10 seminars by 5 manufacturers.
( ) Repair Technician Instructor (program description)
( ) Top Tech, Factory Technician for _______________________________
SPECIALTY:( )Military ( )Police ( )Fire/Rescue ( )Technical ( )Antiquated ( ) Re-breather ( )Spearguns ( )Hardhat ( )Hazmat ( )Oxygen
( ) My information is current with Diving Technologies (formerly w/IAST)
( ) I am including technical background and copies of certificates
(
) I wish to sponsor and be listed on the {SERVICE} or {TRAINING} facility category. Please
indicate (Additional $15)
Facility
name _____________________________________________________
Web site/e-mail
__________________________________________________
I assure that the information
provided is true and correct.
Signature________________________________________
Date_____________
Please send completed application and dues to:
IAST 4574 N. Hiatus Road, Sunrise, FL, 33351
(or) you may fax information w/credit card # to: (954) 748-0637
(or) email information (copy & paste application) w/credit card # to: iastus@aol.com