Name ________________________________________________
Organization___________________________________________
Address ______________________________________________
City/ State ______________________________________
Zip ______________________________________________
Phone _______________________________________________
E-mail________________________________________________
GRPevent. A 50% refund will be given if the refund application
is received less than 5 business days before the event, minus the service and material charges. No request for
refund will be honored on the day of the event. In the case of a tragic emergency payment may be held over for
Send payment (check, credit card or money order) and form to:
Registration GRPA Member
Non-Member
CPSI Course
Exam
Total Due
No on-site registration will be accepted. If you require special accommodations, diet, or assistance with the exam,due to a disability, please attach a note to this application.
Playground Safety Inspector Cer tion Course & Exam
Geo
rgia
Rec
reat
ion
& P
ark
Ass
ocia
tion
1285
Par
ker R
oad
Cony
ers,
GA
300
94w
ww
.grp
a.or
gE-
mai
l: gr
pa@
grpa
.org
Who should attend...
This course is relevant to individuals affiliated with: Park & recreation departments
youth programsches, mosques & synagoguesruction trade unions
ractorsry schools
s, resorts, private clubs & amusement parks overnments
Trade schools
Staff who should attend:chitects rs
ractors rsrs
rs ayground equipment manufacturersayground operators & caretakers
works agers
GRPA/NRPA
Certified Playground SafetyInspector Course
and Exam
Sponsored by:
$415 $440
$110
September 17-19, 2018 Griffin, Georgia
GRPA, 1285 Parker Road, Conyers, GA 30094
Credit Card Form AttachedCancellation Policy
A Service charge of $15 for GRPA/NRPA members, $25 for non-members will be deducted from all refunds. A full
refund, less the service charge and $100 for materials, will
the next year or transferred to another course
CREDIT CARD AUTHORIZATION
Name on Credit Card: _____________________________________________________ Credit Card Billing Address: ________________________________________________
STREET
____________________ __________ ______________
CITY STATE ZIP CODE
Card #: ____________ ____________ ____________ ____________ Expiration Date: ________ __________ CVC Code: ___________________ Authorized Amount to be Charge: ____________________________________________ Email address to send receipt to: _____________________________________________
PLEASE NOTE: All credit card information is
shredded after cards are processed. GRPA does not keep any credit card information on file. This is in
compliance with Payment Card Industry Data Security Standards. (PCI DSS)