ILICA Workshop

Illinois LICA Safety Series

Please register by filling out the form below
Full Name*

First NameLast Name
Company Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Payment method:*

Mail a checkCredit card (4% convenience fee applies)
Are you an Illinois LICA member?*

YesNo
Which location will you attend?*

Decatur, IL: January 9-10Mt. Vernon, IL: January 14-15Lanark, IL: January 23-24
Day 1

9am - 5pm: 10 Hr. OSHA

Day 2

8am - 12pm: 10 Hr. OSHA

1pm - 5pm: Flagger or CPR

Each attendee may register for 10 hr. OSHA and either Flagger or CPR.
Total Number of people attending 10 hr. OSHA*
Total Number of people attending flagger training*
Total Number of people attending CPR training*
Additional attendees' names:
Please mail a check for the total amount shown to Illinois LICA, 112 Exchange St, Ste. 2, Galva, IL 61434
4% Calculation

Illinois LICA Safety Series