The Hartford
Loss Control Seminar
Registration Form
Registrant
Company
Name Title:
Other Attendees
Address
Phone Fax Email
Mark the box for the course(s) you or your associates plan to attend:
3-D Driver Training:
Phoenix Denver Las Vegas
April 14 April 20 June 24
8:00am-2:30pm 8:00am–2:30pm 8:00am–2:30pm
July 14 July 20 August 26
8:00am–2:30pm 8:00am–2:30pm 8:00am–2:30pm
October 27 October 21 November 16
8:00am–2:30pm 8:00am–2:30pm 8:00am-2:30pm
OSHA 10 Hour – Supervisor Construction Safety:
2 day course, June 30 & July 1 (Las Vegas) 7:30am–12:30pm (both days)
Business Continuity Management:
May 26 (Phoenix) 8:00am-12:00pm June 4 (Denver) 8:00am-12:00pm
Workers Compensation 101:
August 18 (Phoenix) 8:00am-12:00pm September 2 (Denver) 8:00am-12:00pm
Supervisor Training Series (Albuquerque, NM):
April 5 7:00am-8:00am Controlling Workers Compensation Costs
May 4 7:00am-8:00am Supervisor Planning & Training
June 8 7:00am-8:00am Supervisor Leadership & Incentives
July 13 7:00am-8:00am Accident Investigations
Automatic Fire Sprinkler System Maintenance:
November 3 (Denver) 8:00am-10:00am
11/22/2011 Loss Control Seminars 2010
Page 1
Company Information:
Company
President, CEO, Safety Director or CFO
Name Title:
Name Title:
Name Title:
Address
City State Zip
Phone Fax Email
Insurance Agency Information:
Insurance Agency The Arizona Group
Agents Name Judy North
Address 3325 E. Baseline Road
City Gilbert State AZ Zip 85234
Phone 480-892-8755 Fax 480-892- Email jnorth@arizonagroup.com
7625
Return this registration form to (mail, email or fax):
The Hartford
Attention: Loss Control Registration
7670 S. Chester St., Ste. 300
Englewood, CO 80112-3439
Agency.feedback@thehartford.com
303-645-8600 (fax)
11/22/2011 Loss Control Seminars 2010
Page 2