TRAINING COURSE REGISTRATION:

Online Course Registration Form

Use this on-line registration form to register for scheduled courses offered by Workplace Hygiene. The form may be submitted online or you may use our printable registration form and fax or mail it to our office at:

445 Dolley Madison Road
Suite C
Greensboro, NC 27410
Fax: (336) 931-0018

You may also register by phone by calling (888) WPI-0001 or (336) 931-5046.

Payment

Payment is due upon registration. You may pay by credit card by using our online shopping cart (follow directions once you've completed this registration form), or by calling us with your credit card number. If paying by check, please make checks payable to Workplace Hygiene. Payments not received 7 days prior to the course date will result in cancellation of registration.

A letter of confirmation along with directions to the facility will be sent after the registration has been received. See course descriptions for specific class times. Workplace Hygiene reserves the right to cancel any course that does not meet minimum registration requirements.

Important: If you cannot attend the class for which you have registered, we will offer you an alternate date(s). Requests for a refund for a class paid for with a credit card will result in a service fee of at least $100.

Where did you hear about this course?

Highlight the source in the list below.

If "other" is selected, please specify

To select more than one source, hold down the "control" key.

Mac users hold down the "command" key.

Personal Information:

Fields in BOLD must be filled out.

First Name:
Last Name:
Credentials:
Other:
E-mail Address:
Cell Phone:

To select more than one source, hold down the "control" key.

Mac users hold down the "command" key.

Additional Attendees

2-First Name:
Last Name:
Credentials:
Other:
E-mail Address:
Cell Phone:

3-First Name:
Last Name:
Credentials:
Other:
E-mail Address:
Cell Phone:

4-First Name:
Last Name:
Credentials:
Other:
E-mail Address:
Cell Phone:

Company Information:

Company Name:
Address:
Address 2:
City:	State:
ZIP+4:
Phone:
FAX:

Comments or Questions:

Course Information:

Please select the course date / location from the drop-down menu below.

Respirator Fit Testing Course

Payment Information:

Please select your payment method. If paying by credit card, we will call you for your card information.

Check

Credit Card (MC, Visa, Amex only)

Purchase Order PO#:


	Contact Us \| Air Monitoring / Exposure Assessments \| Health & Safety Program Development & Audits \| Noise Surveys Respiratory Protection \| Indoor Air Quality \| Industrial Hygiene Training \| Training Course Registration Industrial Hygiene Article Archive \| Privacy Policy Workplace Hygiene 445 Dolley Madison Rd., Ste. C Greensboro, NC 27410 (336) 931-5046 (888) WPH-0001 fax: (336) 931-0018
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