HAZWOPER TRAINING APPLICATION 2012

Directions: Please either complete this application and submit it on-line; or print it, fill it in, and mail or fax to us:

Laurie Bergquist, Admissions Director
North Country Heavy Equipment School, LLC
2929 16th Avenue North
Escanaba, MI 49829		 Phone: 906-789-3123
Fax: 906-789-3124
Email:
info@RunMonsterMachines.com
Name:
Address:
City, State/Prov., Zipcode:
Area Code & Phone Number:
Email Address (required only if submitting on-line):

Please check the 2012 Heavy Equipment course in which you are currently enrolled or plan to attend:

April 2 - April 20 June 25 - July 13 Aug. 27 - Sept. 14
April 23 - May 11 July 16 - Aug. 3 Sept. 17 - Oct. 5
May 14 - June 1 Aug. 6 - Aug. 24 Oct. 8 - Oct 26
June 4 - June 22        

Please check the 2012 HAZWOPER class in which you want to enroll:

April 20 - 22 July 13 - 15 Oct. 5 - 7
June 1 - 3 Aug. 24 - 26    

The cost for the HAZWOPER training is $700. Arrangements for payment must be made before your class starts. How do you plan to pay for HAZWOPER? Please check one:

Personal Check / Money Order Agency / Loan Check Cash
Credit Card Other

Would you like someone to contact you with more information? Yes No Not Sure
Counselor Friend Someone who took the course
TV Radio Flyer
Newspaper Employment Office Website / Search Engine
Other
Please call if you have any questions, 906-789-3123.
Thank You For Your Application!

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