REGISTRATION FORM

Basic 30-Hour APCAP Course and Advanced APCAP Course
October 26-30, 2009 at North Carolina Zoo in Asheboro, NC

NAME:

JOB TITLE:

EMPLOYER:

ADDRESS:

CITY, STATE, ZIP:

E-MAIL ADDRESS:

PHONE: (          )

COURSE REQUESTED (check one):

*You must complete the Basic 30-Hour APCAP Course before taking the Advanced APCAP Course.

MAIL/FAX FORM TO:

N.C. Industrial Commission Safety Education Section
4339 Mail Service Center
Raleigh, NC 27699-4339
(919) 807-2603, Fax: (919) 715-6573
ATTENTION: DENNIS PARNELL
 

N.C. Industrial Commission    Safety Education Section
4339 Mail Service Center
   Raleigh, NC 27699-4339
Telephone: (919) 807-2603
   Fax: (919) 715-6573
NCIC Home Page: http://www.ic.nc.gov/