Wheelchair Hands-on Securement training request
Contact Information of Requester
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Best way to reach you
Please Select
Phone
Email
Txt messages
Where would you like to attend the class?
Please Select
Our location ( Orange Park, FL)
Your office (Jacksonville)
Your site (any other location)
How many drivers do you need to train in Wheelchair Securement?
Have all Drivers completed Online PASS training within the last 6 months?
Yes, all have Online PASS certificare
No, but we'll get them all done prior to class
No (this option may not qualify drivers for Hands-on training)
Tentative Date requested
Submit
Should be Empty: