VORTEX Inc.

Environmental Training Course

Registration Form

COPY THIS FORM

Name/Company Name: ________________________  Date: ___/___/___

Mailing Address: ________________________________________

                          ________________________________________

                          _______________ Zip Code: ________                       

Telephone No: (_____) ____________   Facsimile No: (___) __________

Contact Person: ______________________________________________

E-mail address: ______________________________________________

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Training Course Information

                                                               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.