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SSPC Training Registration Form for PCI Level 1, Level 2,


or Level 3
All information must be typed, not hand written.
*Please e-mail this form to Nicole Lourette at lourette@sspc.org.

Student Contact Information:


1. Name (as it should appear on your certificate):
2. Your Title:
3. Company Name:
4. Address:
5. City:
6. State:
7 .Zip:
8. Country:
9. Area Code/Phone Number:
10. E-mail Address:
11. Area Code/Fax Number Date:

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Please check off which level of the PCI you plan to attend:
Option 1
PCI Level 1: (5 days) - Course you are attending ____________________
(There are no pre requisites for this level.)
SSPC Member $995 USD
Non-Member $1195 USD
I would like to become a member of SSPC
SSPC Electronic Individual Membership Fee $95 USD
SSPC Individual Membership Fee $120 USD

Option 2
PCI Level 2: (6 days) - Course you are attending __________________
(Pre requisites required for this level.)
SSPC Member $1395 USD
Non-Member $1595 USD
I would like to become a member of SSPC
SSPC Electronic Individual Membership Fee $95 USD
SSPC Individual Membership Fee $120 USD

Option 3 (This level is in addition to Level 1 & 2)


PCI Level 3 Exam: (1 day) - Course you are attending __________________
(Pre requisites required for this level.)
SSPC Member $500 USD
Non-Member $700 USD
I would like to become a member of SSPC
SSPC Electronic Individual Membership Fee $95 USD
SSPC Individual Membership Fee $120 USD
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Please charge my credit card:


AMEX
VISA
MasterCard
Card Number:
Exp. Date:
Name on Card:

Please send me your bank details to pay by wire transfer:


I want to pay by bank wire transfer. Please send me your bank information to make payment.

Candidates must pass the PCI Level 1 Course Exams with a 70% or higher prior to sitting for the
PCI Level 2 Certification Exam.
To become a SSPC Level 2 certified coatings inspector, you must pass each component of the Level
2 Certification Exam with a score of 80% or higher.
To become a SSPC Level 3 certified coatings inspector, you must pass the Level 3 exam with a
score of 80% or higher.

SSPC is concerned about protecting the confidentiality of our members. If you pass the course
exams or the certification exams your name and contact information will be placed on our website.
Would you want your information posted on our website? Please check one of the boxes below.

Yes:

No:

If you do not check one of the boxes then your information will not be listed on the SSPC website.

Cancellation Policy
SSPC reserves the right to cancel up to 21 days before the scheduled training is to begin due to
low registration. If a training event is cancelled, registrants receive a full refund of payments for
course fees and supplemental material or SSPC can transfer your registration fee to an upcoming
training. If you do not enroll in another class within one year, the fees will be forfeited.
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If you choose to cancel and SSPC receives your written cancellation:
A) up to 30 days before the training, the registration fee is refundable, minus a $50.00 service
charge or you may select a full credit towards a future training class or event.
B) is received from 29 to 17 calendar days before the training, the fee is refundable at 50%, minus
a $50.00 service charge or you may select a full credit towards a future conference or training
event.
C) is received in 16 or fewer days before the training, you will receive credit towards a future
conference or training event, minus a $50.00 service charge. If you do not cancel or attend, you
are still responsible for the payment. All credits for future classes due to your cancellation are
forfeited if you do not attend another class within one year of your first cancellation. Under no
circumstances is SSPC responsible for reimbursement of any airline tickets, guaranteed
reservations or other expenses associated with a student attending any class.
Special Note: If you have a disability that may impact your participation in this activity, please
call SSPC at least two weeks prior to the date of the event. Prior notification is necessary in order
for us to address your needs.