Course Registration Request

Course Registration Form

By Fax - Print out this form. Fax to (302) 654-4617
By Mail - Delaware Safety Council, 3 Old Barley Mill Road, Wilmington, DE 9807
Electronic - Complete online form and click "Submit"

Cancellation Policy: Cancellations must be received at least 10 business days prior to seminar. There is a 50% charge on late cancellations. No refunds or credits 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. Unless otherwise noted, all courses will be taught in the Delaware Safety Council Classroom at 3 Old Barley Mill Road, adjacent to Hagley Museum.

Delaware Safety Council, Inc.
3 Old Barley Mill Road
Wilmington, Delaware 19807
Phone - (302) 654-7786 Fax - (302) 654-4617
(800) 342-2287 (in state)
Email - desafe@mail.del.net

First Name	Last Name
Title	Employer
Address
Address
City	State
Zip	E-Mail
Phone	Fax
Please register me for the following course(s):
1:	Date:	Number attending:
2:	Date:	Number attending:
3:	Date:	Number attending:
Please Bill Me:
Purchase Order Number
Billing Address
Address
City	State
Zip
Please send me details on on-site training for my employees
Please send me details on the Advanced Safety Certificate