SCAFFOLD TRAINING INSTITUTE

Houston Training Center

311 East Walker Street League City, TX 77573

281-332-1613 Fax: 281-316-2030

CLASS REGISTRATION FORM

(Class Times 8am to 5pm)

Note: Payment prior to start of class is required, see below.

DATE OF CLASS ATTENDING:

COMPANY NAME:

BILLING ADDRESS:

CITY, STATE, ZIP:

PHONE #:

ATTENDEES CELL PHONE #:

PAYMENT INFORMATION: (Payment in advance expected unless special

arrangements are made.)

WILL BRING CHECK:

CREDIT CARD # & Exp.:

Will call prior to class to request special payment arrangements:

Names of Attendee(s) for MODULE 1 "COMPETENT PERSON/INSPECTOR” One day:($150 each).

Names of Attendee(s) for THREE DAY TRAINER COURSE:

($750 each.)

Names of Attendee(s) for FOUR DAY TRAINER(32 hour) COURSE: ($1000 each).

Names of Attendee(s) for FIVE DAY TRAINER(40 hour) COURSE: ($1250 each).

Number of Additional Manuals for Trainers, if needed ($45.each):

AUTHORIZED SIGNATURE