REGISTRATION FORM
Basic 30-Hour APCAP Course and Advanced APCAP Course
August 31-September 4, 2009 at the Sheraton Atlantic Beach
NAME:
JOB TITLE:
EMPLOYER:
ADDRESS:
CITY, STATE, ZIP:
E-MAIL ADDRESS:
PHONE: ( )
COURSE REQUESTED (check one):
( ) Basic 30-Hour APCAP Course—August 31-September 4, 2009
( ) Advanced APCAP Course*—August 31 and September 1, 2009
*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 |