1601 Van Horne Avenue East Brandon Manitoba Canada R7A 7K2Phone: (204) 726-6855Fax: (204) 726-6847Toll Free: [email protected]
INSTRUCTOR CONTACT
UPDATE FORM“Training to Save Lives”
July 2015
___________________________________________________________________________________________________________________In an effort to maintain the Manitoba Emergency Services College (MESC) current instructor contact lists in all of our discipline areas, and to provide continued service to our clientele, we request that our instructors complete an “Instructor Contact Update” form. Please complete the following and place a beside the information that YOU AGREE TO HAVE RELEASED by the to departments requesting program instructors.
Instructor Name:
Program(s) of Instruction in which you are a recognized MESC Instructor:
Release of Information
Contact Information
Home Address (Street/box Number)
Community Postal Code
Home Phone
Work Phone
Cell Phone
Emergency Services Affiliation Mutual Aid DistrictForms can be returned to the Manitoba Emergency Services College by one of the
above avenues.
Signature Date
Office of the Fire Commissioner
