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If you are a front-line supervisor at a National LIFTOR Licensed Industrial Site, you
can
PRINT-OUT and FAX (or mail) this form to register for the Certified Instructor and Test Examiner
Workshop. If you are NOT a front-line supervisor, you can still register
for the two-day supervisor/management practices modules at a cost of
$1400. If
you want to register ONLINE Click
here. |
Register for 4-day LIFTOR Certified Instructor & Test
Examiner Workshop
($3185 pricing good until 10/31/2010.)
My company will Sponsor
a 4-day in-house workshop on a date of our choice at my location. [ ]
I am a supervisor/manager needing ONLY the two-day
supervisor/management practices modules. [ ]
I do NOT have a front-line supervisor or manager title. Please bill
me on the P.O #, Below. [ ]
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Print Name:
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___________________________________ |
Select ONLY one:
I will sponsor in 2010 [ ]
Mar. 23-26, 2010 [ ]
Other Dates, 2010 [ ]
If Licensed
Sponsor,
call 1-888-454-3867 with
preferred Dates
Enter Sponsor
Dates (4days) ______;_____;_____;______
P.O. #:___________________ Authorized Signature:
_________________________ |
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Title:
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___________________________________ |
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Company:
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___________________________________ |
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Address:
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___________________________________ |
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___________________________________ |
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Phone:
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___________________________________ |
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Fax:
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___________________________________ |
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Email:
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___________________________________ |
[ ] Bill me to the
P.O.# entered above[ ] Payment
Enclosed via USPS
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Certified Instructor & Test Examiner Workshop
at $3185/Participant ....................................$_________
Two Day (Non-Certification) Modules
at $1400/participant ...................................$_________
Instructor/Examiner Kit at $285 ea................$_________
Payment Total
.........................................$_________ |
