Course Registration

CORPORATE REGISTRATION
(Company or Organization is paying for you) - Complete Form #1

INDIVIDUAL REGISTRATION
(You do NOT have or belong to a company or organization AND a company or organization is NOT paying for the course.)
Fill out the blue Form #2
(scroll down the page to see it)

If you own or are connected to a company or organization - Please complete the appropriate boxes on the CORPORATE REGISTRATION FORM (Pale Yellow)Note: The company is paying for your course. We will send an invoice to the company.

If you are an individual and NOT associated with a company, please complete the pale blue, INDIVIDUAL REGISTRATION FORM (below the Corporate Form) Note: A company or organization is NOT paying for your course.

FORM #1
CORPORATE CLIENT REGISTRATION

Please note that all fields followed by an asterisk must be filled in.

BUSINESS OR ORGANIZATION NAME*
BUSINESS OR ORGANIZATION NAME*

BUSINESS MAILING ADDRESS

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country

Business Phone*
Business Phone*

Fax

YOUR FIRST NAME *
YOUR FIRST NAME *

YOUR LAST NAME*
YOUR LAST NAME*

YOUR BEST CONTACT PHONE #

OTHER PHONE NUMBERS, CELL, ETC.

COMPANY CONTACT PERSON (First & Last Name)*
COMPANY CONTACT PERSON (First & Last Name)*

May we ask? How did you hear about us?*
May we ask? How did you hear about us?*

	Friend or word of mouth
	Company
	WSCA Silviculture Magazine
	Other Magazine / Alberta
	Other Magazine / B.C.
	Web Search
	Newspaper
	Convention
	Letter
	WorkSafe BC
	Ministry of Forests
	Other

COMPANY CONTACT PERSON'S EMAIL

COMPANY CONTACT PERSON'S PHONE (If different from "Business Phone")

OTHER CONTACT PHONE NUMBERS

PURCHASE ORDER NUMBER

LIST ALL CREW PERSONS BELOW (This needs to be completed only once by your Company Contact / Admin. person)

NO PROVINCE WIDE DATA BASE FOR S-100 or S-100A CARD HOLDERS:
No matter what anyone tells you, at this time and not in the foreseeable future, is there or will there be a Province Wide Data Base for persons who have successfully completed the S-100 or S-100A Courses.

Each instructor must keep their own list of students taught. No one else has access to these lists unless there may be a WorkSafeBC investigation of some type.

EACH STUDENT IS ADVISED TO ENSURE THEY KEEP A RECORD OF THE DATE THE COURSE WAS TAKEN AND THE INSTRUCTOR'S NAME.
This is going to become a major issue in the near future - KEEP RECORDS OF ALL YOUR TRAINING DETAILS

#2
INDIVIDUAL CLIENT REGISTRATION
(A COMPANY NOT PAYING)

Please note that all fields followed by an asterisk must be filled in.

FIRST NAME (WOULD LIKE ON CARD)*
FIRST NAME (WOULD LIKE ON CARD)*

LAST NAME*
LAST NAME*

MAILING ADDRESS*
MAILING ADDRESS*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country

Home Phone*
Home Phone*

Are you a previous customer of www.firesafetraining.com? ... and are paid up to date?*
Are you a previous customer of www.firesafetraining.com? ... and are paid up to date?*

	YES
	NO - I AM A NEW CUSTOMER

May we ask - how did you find us?*
May we ask - how did you find us?*

	Friend or word of mouth
	Company
	WSCA Silviculture Magazine
	Other Magazine / Alberta
	Other Magazine / B.C.
	Web Search
	Newspaper
	WorkSafe BC
	Ministry of Forests
	Other

Payment Method

	Major Credit Card or PayPal Account - Online
	Cheque
	Money Order

If someone else is paying for you, please print their name. It is easier for us to then match your name to the correct payment. ... and you will receive your card quicker.Thanks.

BUSINESS PHONE (OPTIONAL)

OTHER PHONE NUMBERS (OPTIONAL)

EMAIL (OPTIONAL)

COMMENTS (OPTIONAL)

General Manager / Course Administrator - Anne Jones
1-866-916-1866 / (778) 208-0299
Email: firesafe100@gmail.com

Course Instructor and Webmaster - Doug Richardson

Copyright protected under Federal and International Law

SBI!

CORPORATE REGISTRATION(Company or Organization is paying for you) - Complete Form #1 INDIVIDUAL REGISTRATION(You do NOT have or belong to a company or organization AND a company or organization is NOT paying for the course.)Fill out the blue Form #2 (scroll down the page to see it)

CORPORATE REGISTRATION
(Company or Organization is paying for you) - Complete Form #1
INDIVIDUAL REGISTRATION
(You do NOT have or belong to a company or organization AND a company or organization is NOT paying for the course.)
Fill out the blue Form #2
(scroll down the page to see it)