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Under 21.com

SEMI-ANNUAL REPORT FORM
January 1, 2013 - June 30, 2013

for the Illinois Liquor Control Commission Beverage Alcohol Sellers/Servers Education & Training (BASSET) Program

Enter details below or click here for PDF form, which can emailed (Lee.Roupas@illinois.gov), faxed (312-814-2241), or mailed (ILCC, 100 W. Randolph 7-801, Chicago, IL 60601).

Org. Name: 

Contact: 

Address: 
City: 
State: 
Zip: 
   
Phone: 
Email: 
   
Total number of sellers/servers trained: 
Total number of courses scheduled and completed: 
Total fees charged per course:  $
Total number of businesses represented by particpants: 

List name of counties represented by those businesses: