Course Registration Form
Register now to secure your course and/or class.
Contact Information
Please provide the contact information for the point of contact for the requested course.
Full Name
*
First & Last Name
Company
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address of Where the Course Will Be Held
*
Street Address
City
State / Province
Postal / Zip Code
Dates
Please provide three (3) dates which you would like the class to occur. Please note, request for courses must be submitted at least two (2) weeks prior to the requested dates. This allows us to ensure that we can have the proper materials for the course.
Requested Date #1
*
/
Month
/
Day
Year
Date
Requested Date #2
*
/
Month
/
Day
Year
Date
Requested Date #3
*
/
Month
/
Day
Year
Date
Class Information
Please provide information regarding the class you are requesting
Which class would you like to register for?
*
Please Select
Qualified Flagger (4-hour Course with Certification)
Basics to Traffic Control (2-hour non-certification course)
How many people will be attending the class?
*
Additional Comments or Questions
By clicking "Submit" below, I agree that the information provided above is true and correct to the best of my ability. I also understand that there is a non-refundable fee of $150 applied for all courses. This fee is in addition to fees per student depending on the course requested. I also agree to pay for the costs of the course once reviewed by staff members of LACA Traffic Solutions LLC. An invoice will be provided and payment will be required prior to confirming the course registration.
*
I Agree
Please verify that you are human
*
Submit
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