RESIDENTIAL CONTINUING EDUCATION REGISTRATION FORM

Construction Contractors Board
PO Box 14140 Salem, OR 97309-5052
700 Summer St. NE, Suite 300
Salem, OR 97301-1287
503-378-4621 www.oregon.gov/ccb
RESIDENTIAL CONTINUING EDUCATION REGISTRATION FORM
JLC Live, Oregon Convention Center in Portland
This form registers you for 1 hour of CCB’s Laws, Regulations and Business Practices (LRB) courses.
ATTENDEE INFORMATION
Name
Status
□Owner
Mailing Address
City, State
Telephone Number
(
)
□Employee
Zip Code
e-Mail Address
BUSINESS INFORMATION
Business Name
CCB License No.
Mailing Address
City, State
Zip Code
CLASS INFORMATION
The CCB will offer an hour-long “Maintaining Your License” class at this year’s JLC Live Northwest at the Oregon
Convention Center.
Details:
 Class starts at 11 a.m. Friday, Dec. 5.
 Your $15 class fee covers admission to the event, which includes other clinics and exhibits.
Residential contractors need three hours of CCB classes every two-year renewal period. This counts as one of those
hours.
PAYMENT INFORMATION $15
□
□
Credit card $15 payment: (Complete the information below)
Mail registration & $15 check (check payable to CCB)
Cardholder Name
Billing Address
City, State
Check if same as above:
Telephone Number
(
)
Zip Code
e-Mail Address
Card Type:
□ Visa
□ Mastercard
□ Discover
Card Number:
Expiration Date:
Signature of Card Holder:
Date:
*Please fax registration/credit card information to CCB’s secure fax at 503-373-2155,
Or Mail registration and payment to: CCB PO Box 14140 Salem, OR 97309-5052
E:CE/RCE/pndltn 10-14

Download Report