HomeSafe Environmental Training Registration

HomeSafe Environmental Training
(NOTE: To register for a "web" class, go: HERE)

Register Below for Onsite (classroom) Classes
To register please complete all sections of the below form. This registration method holds space for 72 hours. After that, all fees must be paid in full to hold your seat. We accept Credit Cards, Business Checks, Money Orders, & Purchase Orders.

For Credit Cards:
Complete the form, then use our Secure Checkout powered by Authorize Net

For Checks/Money Orders:
Complete each section of the form below, then send Check or M.O. (U.S. Funds) payable to HomeSafe Environmental to:

HomeSafe Environmental, Inc.
Attn: Training
24662 Redlands Blvd
Loma Linda, CA 92354

For Purchase Orders:
To use a Purchase Order, complete all sections of the form below AND type the P.O. # in the "Student Name" text box. Please call 1-800-648-5323 to confirm.

(Note: Students will not be admitted unless payment arrangements are complete.)

An entry for each numbered item is REQUIRED.
If "Not Applicable" type: N/A.

Section A. Company Contact (Person responsible for registration)

1. Name:

2. Email address:

(e.g.: name@aol.com)

3. Company/Agency Name:

4. Address:

5. City:

6. State:

7. Zip:

8. Business phone #:

(include AC)

9. Business fax #:

( include AC; if none put N/A)

Section B. Course Info

10. What course(s) are you registering for?
(Check all that apply - All classes in English unless noted)

- Lead Worker (W3) $395.00
- Lead Supervisor / Monitor (SSPM) $295.00
- Lead Sampling Technician (ST) $170.00
- Lead Inspector / Assessor (IA) $695.00
- Lead General Refresher (CEG) $160.00
- Lead Worker Refresher (CEW) $160.00
- Lead Worker Refresher (Spanish) (CEWSp) $160.00
- Lead Awareness (LAW) $125.00
- Mold Awareness (MAW) $195.00
X - EPA 1-Day Renovation, Repair & Painting (RRP-I) Call Sponsor
- EPA 1/2-Day RRP Refresher (RRP-R) $95.00

11. What is the course start date? (i.e. 6/24/2009)
Not sure? Check Schedule. Hit browser "Back" button to return.

Section C. Student Info

12. How many student's are you registering? (1,2,3 etc.)

13. List student's name(s): (First, MI, Last)

If more than one student, list additional names on separate lines.

Section D. Payment

14. How do you intend to pay? (Select one)
Credit Card - Make Payment Now
Check - Mail to above address (U.S. Funds).
P.O. - Fax copy to (909) 796-2155

15. Total amount due:(i.e. $295.00)

16. Type Verification Code Shown:

REMEMBER ... your registration is not complete and a seat will not be confirmed until we have received full payment.

When you are finished, hit the REGISTER button once. Thanks!

An entry for each numbered item is REQUIRED.
If "Not Applicable" type: N/A.

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