Online forms: OSHA Training Registration

1. First Name Required

2. Middle Initial Required

3. Last Name Required

4. Additional Name

5. Birth Date Required

6. Are you a US Citizen / Permanent Resident? Required

Yes No

7. Gender Required

Male Female

8. Permanent Address Required

Business Address Personal Address

9. Street Required

10. City Required

11. State Required Please select ... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

12. Zip Required

13. Phone Required

14. Alt Phone

15. Email Required

16. Would you like to be notified of upcoming training opportunities? Required

Yes No

17. What is your race? Select one or more of the following Required

American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White

18. Are you a Butler Community College Employee? Required

Yes No

19. How did you learn of BETA and our course offerings? Required

20. Which course are you interested in? Please select ... OSHA 500 - Trainer Course in Standards in the Construction Industry OSHA 501 - Trainer Course in OSHA Standards for General Industry OSHA 502 - Update for Construction Industry Outreach Trainers OSHA 503 - Update for General Industry Outreach Trainers OSHA 510 - Occupational Safety and Health Standards for the Construction Industry OSHA 511 - Occupational Safety and Health Standards for General Industry OSHA 521 - OSHA Guide to Industrial Hygiene OSHA 2015 - Hazardous Materials OSHA 2045 - Machinery and Machine Guarding Standards OSHA 2055 - Cranes in Construction OSHA 2225 - Respiratory Protection OSHA 2255 - Principles of Ergonomics OSHA 2264 - Permit-Required Confined Space Entry OSHA 3015 - Excavation, Trenching and Soil Mechanics OSHA 3095 - Electrical Standards OSHA 3115 - Fall Protection OSHA 7405 - Fall Hazard Awareness for the Construction Industry OSHA 7410 - Managing Excavation Hazards OSHA 7505 - Introduction to Accident Investigation OSHA 7845 - Recordkeeping Rule Seminar

21. Date Required

22. PERSONAL PAY

Check Cash Credit

23. COMPANY PAY

Check Cash Credit

24. Company Name

25. INVOICE NEEDED? Required

Yes No

26. REFUND POLICY A full refund is given if BETA cancels a class OR if a participant withdraws at least 7 days prior to the date of the class. A refund, less a $20 Processing Fee, is given if a participant withdraws 2-6 days prior to the date of the class. No refund is given if a participant withdraws less than 48 hours prior to the date of the class. PAYMENT POLICY Registration constitutes responsibility for payment. Payment by cash or check must be received 7 days prior to the date of the class, unless secured with a credit card. If your employer or organization declines to pay for the class for any reason, you are responsible for payment. Required

I HAVE READ AND UNDERSTAND THE BETA REFUND & PAYMENT POLICY STATEMENTS