MSHA Training Course Registration Form

MSHA Training Course Registration Form

Please fill out the form to register for the class.
You must look at our site or call 575-835-5460 before starting this form to make sure the date(s) you are requesting are available.

https://www.nmt.edu/research/organizations/mines/schedule.php
Course Information
Point of Contact: Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Please choose your MSHA course trainer*
Preferred Course Start Date*
If this date(s) is available, we will contact you and book you right away. They normally run from 8 am - 5 pm. Fill out the next question if you need a different start time.
Time

Hour Minutes

AM/PM Option
Location/Address of where course will be conducted. If it will be at our location, the address is: 101 East Road, Socorro, NM 87801*

Street Address and Suite Number (is applicable)

Office/Conference Room Number and/or Name

CityState / Province

Postal / Zip Code
Part 46 or Part 48?*
Part 46: Do you have a training plan?
Part 46: If you have a training plan, is is up to date? Please upload the file here, so that the trainer can review it.
Part 46: Training Plan - File Upload

Cancelof
Select The Needed Course*
Select Additional Courses (ex: If you need Annual Refresher and New Miner. ex: New Miner + First Aid. ex: Annual Refresher + First Aid)*

No Additional Class NeededNew MinerAnnual RefresherAnnual Refresher with First AidFirst AidNSC First Aid
How many people will attend the class? *
Class minimum is 6 people. If there will be less then 6, we are required to charge for 6 people. Small classes (5 or less) will have to held at our location.
Please list the names of the attendees*
We understand that the final list may bot be the same as what is listed here.

Company Information
Company Name/Individual Name*
Mine ID Number
Please put N/A if this does not apply.
Phone Number*
Please enter a valid phone number.
We are looking to start electronically sending invoices. What is the best email to send them to?*
example@example.com
Mailing Address *

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are the mailing and physical address the same?*
If yes, skip next question.
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code

Safety Officer/Safety Manager Information
Safety Officer/Safety Manager Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

The invoice will be processed once the class has taken place. Please ensure that your attendees fill out the sign-in sheet clearly. You can scan the QR code below to make a payment upon receiving invoice.
Should be Empty:

MSHA Training Course Registration Form

You must look at our site or call 575-835-5460 before starting this form to make sure the date(s) you are requesting are available.

Course Information

Company Information

Safety Officer/Safety Manager Information

The invoice will be processed once the class has taken place. Please ensure that your attendees fill out the sign-in sheet clearly. You can scan the QR code below to make a payment upon receiving invoice.