Special-Req

INDUSTRIAL SAFETY TRAINING COUNCIL
SPECIALIZED TRAINING CLASS REQUEST AND AUTHORIZATION FORM

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All information must be provided before the class will be scheduled.

Company Name:

Client ID:

PO #:

Street Address:

City:

State:

Zip: (Format 77702)

Primary Phone Number: (Format 555-555-5555):

Fax: (Format 555-555-5555):

eMail Address:

Requested Class Date:

Classes Requested:

Class Cost: per participant + $5.00 Social Security verification

Number of participants attending:

ISTC Location:

3166 Decker Dr., Baytown, TX 77520

3749 Hwy 69 North, Beaumont, TX 77705

Other

Other Location:

All special requested classes require a minimum of 4 participants.

All non-subscribers will be required to pay for training prior to completion of class.

The company above will be responsible for all travel expenses incurred by ISTC personnel when training takes place at a location away from
an ISTC facility.

A minimum of 48 hours is required for all cancellations. All cancellations with less than 48 hours or no-shows will be billed full price.
Substitutions are allowed.

Approved

Company Representative

Electronic Signature:

International Safety Training Council

INDUSTRIAL SAFETY TRAINING COUNCIL
SPECIALIZED TRAINING CLASS REQUEST AND AUTHORIZATION FORM

Training Facilities

Background Check

Occupational Services

INDUSTRIAL SAFETY TRAINING COUNCILSPECIALIZED TRAINING CLASS REQUEST AND AUTHORIZATION FORM

Training Facilities

Background Check

Occupational Services

INDUSTRIAL SAFETY TRAINING COUNCIL
SPECIALIZED TRAINING CLASS REQUEST AND AUTHORIZATION FORM