APPLICATION

NAME- __________________________________________________________

ADDRESS- _______________________________________________________

CITY- __________________________________________________________

STATE - ________________________________________________________

ZIP CODE - ______________________________________________________

DATE OF BIRTH - _________________________________________________

LICENSE NUMBER - ________________________________________________

DATES OF BRC REQUESTED - SELECT 3 -(1)_____________________________

(2)_______________________________ (3)___________________________

PHONE NUMBER - _________________________________________________

E-MAIL ADDRESS - ________________________________________________

TOTAL COST - $350.00

DEPOSIT - $200.00 - BANK CHECK OR MONEY ORDER ONLY IS REQUIRED

NO PERSONAL CHECKS ACCEPTED

FIRST COME - FIRST SERVE - NO REMINDERS AFTER CONFIRMATION

SEND TO:

ALMRE

40 Gammon Ave.

Auburn, Me. 04210

Cancellation - Refund Policy: 100% - 72 hours or more notice

50% Refund 48 - 72 hour notice -- Less than 48 hours notice - 0% Refund