In-person
Mail:

Truck Division:
 2990 Norland Ave.,
Burnaby, British Columbia
V5B 3A6


Welcome to NSDS Truck Division
Vancouver, British Columbia, Canada

REGISTRATION FORM


Fax:

Truck Division:
(604) 294-4774
Car Division:
(604) 689-8587

PERSONAL INFORMATION

Gender: Male ___ Female ___ Occupation: _______________________________
       
Last Name: _____________________________

First Name: ____________________________________

 
Preferred Name: ________________________  

Address:______________________


Apt. #: _____

 
Business Address________________________
Postal Code: ______   City: ___________________________________
   

Phone #: _______________________________

 Business #: ____________________ Ext: ________

Cell: _____________________________


Fax #: _______________________________

 
Birth Date: ____________ _________

Email: ________________________________

 
DRIVER LICENSE


Driver Lic. #: _____________________

Issue Date: ______________________


Current Lic: _________________________________

Expiry Date: _________________________________


Non BC Lic.#: _____________________

Origin Of Issue: ___________________


Restrictions: ___________________________

 

COURSES OR CERTIFICATES ATTENDED

Air Brakes: ____________________ Pre-trip: ______________________
Truck Theory: __________________  

DESIRED COURSE PACKAGES/CATEGORIES

Course 2 _____ Course 3 ______ Course 4 _______ Course 5 ______
Course 6 ______ Class 2_____    
Class 3______ Tandem Axle Van: _________________
   

TARGET CLASSES / DATES

Air Brake Course Pre-Trip Course Truck Theory Course
Air Brake Endorsement Private Pre-Trip Inspection Chain-up
Private Bus Pre-Trip Private Bus Theory    
Transportation of Dangerous Goods GPS & Computer Log Systems    
National Safety Code Load Securement

PAYMENT OPTIONS

** For security reasons
do not provide any card numbers in this form **

Visa: ____

 Master Card ____

Cash ____

 Debit____

LESSON TIMES PREFERRED

(e.g. Monday after 2pm, Tuesdays unavailable)

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COMMENTS

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