VORTEX Inc.
Environmental Training Course
Registration Form
COPY THIS FORM
***** WE ACCEPT ALL MAJOR CREDIT CARDS *****
Name/Company Name: ________________________ Date: ___/___/___
Mailing Address: ________________________________________
________________________________________
_______________ Zip Code: ________
Telephone No: (_____) ____________ Facsimile No: (___) __________
Contact Person: ______________________________________________
E-mail address: ______________________________________________
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Training Course Information
# | Name | Type of Course | Date of Course | Rate/Course |
1 | | | | $ |
2 | | | | $ |
3 | | | | $ |
TOTAL COST $__________
Please mail or fax (401-738-7869) this completed form to Vortex Inc. a
minimum of 5 days prior to the start of a training course.
Payment-in-full is required prior to starting a course [company check or
Money Order], mail to:
Vortex Inc., P.O. Box 6060, Warwick, RI 02887
Course confirmation shall be returned via phone call or e-mail within 24
hoursof receipt of facsimile or mail. Reproduce this form as needed.