FacebookThis field is for validation purposes and should be left unchanged.Today's Date* MM slash DD slash YYYY Date of Course* MM slash DD slash YYYY Name*Date of Birth*Company Name*Health & Safety Coordinator*Company Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*FaxEmail*Occupation*Years of experience in hazardous materials*Date and location of original 40 hour training*Professional License number for Continuing Education Credit*Fees: $175 per person, $160 each when 3 or more are registered at the same time. Terms: Pre Payment is required. Certificates will not be issued until payment is received in full Reservation Policy: Cancellations with more than 24 hours notice will allow the scheduled attendee to attend the next course. No notice will forfeit the course fees in full. The attendee acting as an agent for the company accepts these terms.* Agree DIgital Signature*By signing your full name, you are agreeing to the terms above.Number of People*Please enter a number from 1 to 30.PriceBulk Discount Price: $0.00 Total $0.00 CAPTCHAAfter filling out this form you will be redirected to paypal where you can input your payment.
