REGISTRATION FORM

FREE* Basic 30-Hour Accident Prevention Certificate Awareness Program
Presented by N.C. Industrial Commission Safety Education Section
June 15-19, 2009
at the
 Town of Smithfield
Town Hall
111 South 4th Street
Smithfield, NC 27577

*There will be a $4.00 per person charge, payable at the workshop,
to cover the defensive driving course book.

There are two ways to register:

  1. Print out and fill in the REGISTRATION FORM FOR SMITHFIELD APCAP COURSES and mail or fax it 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

  1. Register online via the E-MAIL REGISTRATION FORM FOR SMITHFIELD APCAP COURSES.

Note: The Comfort Inn is offering a rate of $63.75 per night, plus tax, for the Smithfield APCAP. Please make hotel reservations directly with the Comfort Inn, 170 S. Equity Drive, Smithfield, NC 27577; (919) 938-4444. When making reservations, please mention NCIC, which is the Promotion Code for special room rates!

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/