COURSE REGISTRATION FORM

Please register the following person(s) for classes checked below:

* Feb. 25 - OSHA Trenching, Excavation and Soil Mechanics Training * Feb. 25 - OSHA Permit Required Confined Space Entry Training * Mar. 3 - OSHA Electrical Safe Work Practices and NFPA 70E - 2009 Version
* Mar. 4 - Incident Investigation Training & Introduction to Root Cause Analysis
* Mar. 4 - OSHA Record Keeping and Injury Classification Training
* Mar. 11 - Conducting Safety Audits and Inspections
* Mar. 11 - Residential Construction Safety Requirements
* Mar. 18 - Forklift Safety Instructor Development Course
* Mar.. 19 - CPR Certification Training
* Mar. 19 - First Aid Cerification Training
* Mar. 29 - Contractor Safety in Highly Hazardous Work Locations

Name(s)                                                                                                                                                                    

                                                                                                                                                                                

                                                                                                                                                                                

                                                                                                                                                                                

                                                                                                                                                                                

Company                                                                                                                                                                  

Address                                                                                                                                                                    

                                                                                                                                                                                

Phone#                                     Fax #                                     email:                                                                         

* Check enclosed for person(s): $                          * Purchase Order #                                            

* Visa or MasterCard No.                                                                                                  Exp. Date:                         



Signature:                                                                                    

Please print out form & Mail to:

Delaware Safety Council, Inc., 3 Old Barley Mill Road, Wilmington DE 19807
or FAX to 1-302-654-4617

Cancellation Policy: Cancellations must be received at least 48 hrs. prior to seminar.  There is a 50% charge on late cancellations.  No refunds or crdeits can be made on non-canceled registrations.  Delaware Safety Council reserves the right to cancel classes in the event of unforeseen circumstances or a lack of enrollments.