Course Enrollment Form

Environmental Health & Safety Management Certification Course, for Business and Industry. Independent Study Note: This course is not downloadable. Indicate below whether you want it on CD/DVD or Hardcopy. Environmental Health & Safety Management Certification Course, for Construction. Independent Study Note: This course is not downloadable. Indicate below whether you want it on CD/DVD or Hardcopy. Workplace Safety Manager/Trainer Course: Areas of Specialization and Certifications: STS Certification SPS Certification HAZWOPER Specialization with HTS Certification Will take as an independent study Classroom Course Date: CSM (Certified Safety Manager) Note: Specify Safety Manager/Trainer Course date above CSA (Certified Safety Administrator) Note: Specify Safety Manager/Trainer Course date above MSA (Master Safety Administrator) Note: Specify Safety Manager/Trainer Course date above Workplace Violence Independent Study Send me information on:

Delivery Information: Name: Company: Address 1: Address 2: City:       State: Zip Code:         Country: Voice Phone: Fax: Email:    Send Course on CD rather than me downloading it - additional $12.95 s/h  (no additional charge for EHS Management Course)     Send Hardcopy - additional $50.00 s/h/ fee

Billing Information NOTE: Credit Card and Official Purchase Orders* are shipped next day. Payment by check delays shipment until check clears but it does not prevent you from downloading course materials. An official Purchase Order means you place a company generated PO number in the block below and FAX a copy of your company's official Purchase order to (704) 487-1579. In this manner a Purchase order is a legal contract and will be treated as such. Secure Access Your Order is Protected by SSL Security Credit Card: American ExpressDiner's ClubDiscoverMasterCardVISA Card Number or PO #:       Exp: (MM/YY) Cardholder Name: Security Code Visa and MasterCard 3 digit Security Code from Rear of Card   I'm mailing a check Special Information

Safety Manager/Trainer Course Tuition and Cancellation Policy  Timely Registration = Lower Tuition! The tuitions listed on our website apply when you register and pay your tuition at least four weeks before the course. Later registration increases tuition by 5%. Tuition must be paid prior to the course date. Once you register, IASP begins to incur costs in processing your order, setting up your IASP files, sending pre-class materials, and preparing your course materials. Therefore full refunds are not provided. Our policy is as follows: 1. You may reschedule for another course with no additional cost. 2. You may substitute another student in your place with no additional cost. Please advise us one week before the course date if possible. 3. Cancellation four weeks or more in advance of the course date: 80% refund. 4. Cancellation three weeks in advance of the course date: 60% refund. 5. Cancellation two weeks in advance of the course date: 40% refund. 6. Cancellation less than two weeks in advance of the course date receives no refund.