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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 modules. If
you want to register ONLINE Click
here. |
Register for 4-day or 2-day Certified Instructor & Examiner Workshop
My company will Sponsor
a 4-day in-house workshop on the dates of our choice at my location.............[ ]
I am a NON-supervisor/manager needing ONLY the two-day
instructional modules..................................[ ]
I'm a front-line supervisor/manager with operators directly reporting to me. I
pay ONLY for the 2012 Kit.....[ ]
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Print Name:
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Select ONLY one:
I will sponsor in 2012 [ ]
Mar. 19-22, 2012 [ ]
Other Dates, 2012 [ ]
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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National LIFTOR Instructor &
Examiner Guide and Kit ......$ 485
Two Day (NON-Front-Line Supervisor) Modules at............$2195
Payment Total
................................................$_________ |
