EPT Course Tuition Benefit Application Full Name: UA #: Address: City/Prov/Postal Code Phone: Email: Course Name: Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Cost of Course:*Books and certification fees are not eligible for benefit* CertificateMax. file size: 50 MB.ConsentI authorize the Edmonton Pipe Trades Trust Fund and ATB to use the services of any member or affiliate of the Canadian Payments Association (CPA) in carrying out this authorization. I agree to be bound by the standards, rules, and practices of CPA as they may exist from time to time. I agree to give written notice of cancellation of this authorization to Edmonton Pipe Trades Educational Trust Fund and be bound by this authorization until the Edmonton Pipe Trades Educational Trust Fund has had reasonable time to act on the notice. Edmonton Pipe Trades Educational Trust Fund and/or ATB may terminate this authorization by providing me with ten (10) days’ notice. I undertake to inform Edmonton Pipe Trades Educational Trust Fund within five (5) days of any changes to branch, account, and institution number while this authorization is in effect. I consent to the following authorizationVoid Cheque/Direct Deposit InformationMax. file size: 50 MB.HiddenOffice Use OnlyHiddenDate Reviewed: MM slash DD slash YYYY HiddenDues in Good Standing? Yes No HiddenApproved Yes No HiddenSafety Manager Update? Yes No HiddenIf declined, what is the reason?HiddenReviewed by: HiddenCourse Name: HiddenInvoice Date: HiddenTotal Amount: HiddenIssued On:
