Course Registration Form One Registration Form Per Student Course Name: Asbestos Contractor Supervisor Initial (40-Hours) Asbestos Contractor Supervisor Refresher Asbestos Building Inspector Initial (24-Hours) Asbestos Building Inspector Refresher Asbestos Management Planner Initial (16-Hours) Asbestos Management Planner Refresher Asbestos Project Designer Initial (24-Hours) Asbestos Project Designer Refresher Asbestos Worker Initial (32-Hours) Asbestos Worker Refresher Asbestos Construction Craft Worker-Roofer (8-Hour) Asbestos Operations & Maintenance Initial (16-Hours) Asbestos Operations & Maintenance Refresher Hazardous Waste Operator Initial (40-Hours) Hazardous Waste Operator Refresher Mold Remediation Supervisor (24-Hours) Mold Remediation Refresher 2-Hour Asbestos & Lead Awareness Floor Tile Drilling Class Lead OSHA Hazard Communication Course Date: Student Name(Last Name, First Name, Middle Initial): Company Name: Company Address: Company Phone: Fax: E-mail: Home Address: Home Phone: Cell: E-mail: Tuition is due three (3) days prior to the first day of class. Checks are made payable to Design For Health Training Center. Please Note: Certificates will not be issued if payment has not been received or an arrangement has not been confirmed by our office. When enrolling for a refresher course, you MUST submit a copy of your previous certificate with this registration form or bring the certificate with you to class. Credit is issued when there are fewer than 3 people registered 48 hours prior to start date and the class is subject to cancellation. (Student will be automatically moved to next scheduled class) REQUEST for refunds are subject to a $25.00 per course processing fee. Start Time: All classes will begin at 9:00 AM unless otherwise specified. Please print and fax a copy of this form Fax To: (619) 291-4318
Home Phone: Cell:
E-mail:
Tuition is due three (3) days prior to the first day of class. Checks are made payable to Design For Health Training Center. Please Note: Certificates will not be issued if payment has not been received or an arrangement has not been confirmed by our office. When enrolling for a refresher course, you MUST submit a copy of your previous certificate with this registration form or bring the certificate with you to class.