Workshop Registration Form

2020\2021 Registration Form

Please fill out the form below to attend regulatory training courses.
Any questions please call the training department (716) 748-8288

Check out our webpage at
www.hazmatinc.com
Name *

First Name Last Name
E-mail *
Name

First Name Last Name
E-mail
example@example.com
Name

First Name Last Name
E-mail
example@example.com
Name

First Name Last Name
E-mail
example@example.com
Name

First Name Last Name
E-mail
example@example.com
Company *
Address *

Street Address

Street Address Line 2

City State

Zip Code Country
Phone Number *

Area Code Phone Number
Cell Phone

Area Code Phone Number
WHICH SEMINAR WILL YOU BE ATTENDING? (PLEASE CHECK ONE)
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RCRA Hazardous Waste Management $ 425.00

Number of People
Item subtotal: $ 0.00

Advanced RCRA Workshop $ 450.00

Number of People
Item subtotal: $ 0.00

USDOT Hazardous Materials Transportation $ 485.00

Number of People
Item subtotal: $ 0.00

IATA Dangerous Goods $ 375.00

Number of People
Item subtotal: $ 0.00

Current IATA Dangerous Good Manual $ 380.00

Number of Books
Item subtotal: $ 0.00

Total $ 0.00
RCRA Hazardous Waste Management Course Date
Advanced RCRA Workshop Course Date
USDOT Hazardous Materials Transportation Course Date
IATA Dangerous Goods Course Date
**Attendees will need the current IATA Dangerous Goods Regulations for this training. You can bring your own or order the book during this registration process.**
Form Of Payment *
Mailing Address:

60 Commerce Dr.
Lackawanna, NY 14218
Payment Contact *

First Name Last Name
Phone Number *

Area Code Phone Number
The payment contact will be contacted for payment upon submission and approval of this form.
E-Mail Confirmation letter to be sent to (Attention):
example@example.com
Clicking submit emails this completed Registration Form to:

Sue Penksa
spenksa@hazmatinc.com
** If anyone has any food allergies please let us know **
Please add any additional notes or questions you may have:
*You can also put additional registrant Names and Email addresses here*
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2020\2021 Registration Form