Safety Training Schedule

On-site Questions? Call Desta in Charlotte at (704) 644-4221 or Matt in Raleigh at (919) 719-9818

Number of Employees	One Year	Three Year
1-49	$499	$1,272
50-100	$549	$1,400
101-500	$849	$2,165
501-1,000	$1,399	$3,567
Total Member Dues: $

REGISTRATION (Pre-payment Required):

Course Title:

Course Location: Course Date:

Contact

NAME of Attendee: (Please Print) Full Name & Preferred Name JOB TITLE: COST:

Company Member # Non-Member

Address

City State Zip Code

Telephone Email

METHOD OF PAYMENT:

Total Amount Due:

	Payment enclosed (4135 S. Stream Boulevard, Suite L150, Charlotte, NC 28217 or 5171 Glenwood Avenue, Suite 105, Raleigh, NC 27612)
	Send invoice. P.O. # (With approved credit only – IF NO PO is required, enter authorizing person’s name)
	VISA/MC/Amex/Discover# Verification Code Expires

Cardholder Signature

E-MAIL REGISTRATION TO: destah@safetync.org in Charlotte susanm@safetync.org in Raleigh

CANCELLATION POLICY: We hope you do not have to cancel, but if you need to do so, cancellation notices received in writing seven (7) or more days prior to the first day of class will be refunded in full less a $50 administrative fee. Cancellations received less than seven (7) days before the first day of class will be refunded 75% of the course fee in the form of a SHCNC Voucher for future training. Unused Vouchers expire one year after date of issue. Substitutions are welcomed. No shows and cancellations received after the start of class will not be eligible for a refund. This policy will be enforced so please plan ahead if you need to cancel.