Pacific Training-Registrations-On Site

Please complete this form and fax to 503-722-9122

REGISTRATION FORM

NAME

REGISTRATION

Company:

Session date:

Address:

PAYMENT TYPE

Credit Card: Check:

City:

Zip:

If paying by check please remit to:

Pacific Training
PO Box 16
West Linn, OR 97068

If paying by credit card please call (503)702-3222. An additional sheet will be faxed with confirmation.

(Cancellations received later than 3 days prior to seminar subject to a $25.00 service charge)

State:

Phone:

Fax:

Email:

EMPLOYEE INFORMATION

Employee names :

List the hazardous materials shipped or received.

PRICING INFORMATION

2 Day DOT/IATA $395.00 (If 3 or more employees $295.00 ea.)

1 Day DOT ground $235.00 (If 3 or more employees $195.00 ea.)

QUESTIONS & COMMENTS

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