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
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Name
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Type of Course
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Date of Course
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Rate/Course
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1
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$
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2
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$
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3
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$
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TOTAL COST $__________
Please mail or email this completed form to Vortex Inc. a minimum of
5 days prior to the start of a training course. Classes may be
canceled if pre-payment is not received within this time period.
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
hours of receipt of email. Reproduce this form as needed.