DOT Hazardous Materials Transportation Refresher by aqu16527


									                                                                           50% TUITION WAIVER APPLICATION
           REGISTRATION FORM                                         STATE & LOCAL GOVERNMENT EMPLOYEES ONLY
        DOT Hazardous              International Air Transport
    Materials Transportation           Association (IATA)        Course ______________________________________________

                                                                                                                                       Salt Lake City, Utah
                                                                                                                                       NONPROFIT ORG.
           Refresher                        Refresher

                                                                                                                                       U.S. Postage Paid
             July 15                         July 16             Participant ___________________________________________                                                                       Rocky Mountain Center

                                                                                                                                       Permit No. 1529
                                                                                                                                                                                                for Occupational and
                                                                                                                                                                                                Environmental Health
                                                                 Title ________________________________________________
NAME_______________________________________________              Company Name _______________________________________
TITLE________________________________________________            Type or Organization or Industry __________________________

INSTITUTION _______________________________________              Number of employees _________email ____________________

ADDRESS __________________________________________
                                                                 Address _____________________________________________                                                                   DOT
                                                                 City ______________________ State ______ Zip ____________
CITY/STATE/ZIP ______________________________________
                                                                 Phone # (     ) ____________ Fax # (       ) _____________
DAYTIME PHONE ____________________________________

EMERGENCY PHONE _________________________________
                           (in case of course cancellation)
                                                                 Please explain your role as a state or local government employee                                                      Materials
                                                                 as it relates to hazardous substances work.
FAX # ______________________________________________

EMAIL ADDRESS _____________________________________              __________________________________________

SPECIALTY:     Industrial Hygienist     Nurse
               Safety Professional  	 	 Physician              __________________________________________
               Other _________________________
                                                                 __________________________________________                                                                                July 15, 2010
ORGANIZATION:           Government 	  Industry                 __________________________________________
                        Private/Self  Academia                 __________________________________________
                        Other______________________
                                                                 __________________________________________                                                                                           and
    Please charge my MasterCard VISA AMEX                    __________________________________________
          Card Number               Expiration Date              __________________________________________
                                                                                                                                                                                    International Air
          Name on Card            Address on Card (Required)

                                                                                                                                    Department of Family & Preventive Medicine
                                                                 __________________________________________                                                                            Association

                                                                                                                                    Rocky Mountain Center for Occupational
 I have enclosed my tuition check for:

 	 DOT Hazardous Materials Refresher: $175                      __________________________________________
   IATA Refresher: $155
 I will forward payment based upon acceptance of my 50%
   tuition eligibility (see application form)
     Please bill me against Purchase Order # __________          __________________________________________

                                                                                                                                     and Environmental Health

                                                                                                                                    Salt Lake City, Utah 84108
                                                                                                                                                                                           July 16, 2010

                                                                                                                                    391 Chipeta Way, Suite C
PLEASE make check payable, direct questions and mail to:
                                                                   For fee waiver consideration, applications must be received
     RMCOEH                                                        BEFORE the course begins.

                                                                                                                                    University of Utah
     Registration Coordinator
     University of Utah                                                                                                                                                           These courses are offered in cooperation
     391 Chipeta Way, Suite C
     Salt Lake City, Utah 84108                                                      Please fax or mail this                                                                     with the National Institute for Occupational
     Telephone: (801) 581-4055                                                       application along with                                                                        Safety and Health, Centers for Disease
     Fax: (801) 585-5275                                                             registration form.                                                                             Control, Public Health Service, U.S.
                                                                                                                                                                                 Department of Health and Human Services.
                                                                      REGISTRATION                                                LOCATION                                    UPCOMING TRAINING COURSES
      HAZARDOUS MATERIALS                              Advance registration is preferred. Payment IN          These courses will be held in Salt Lake City, Utah.
        TRANSPORTATION                                 FULL must be received prior to the start of the        Information regarding accommodations will be              OSHA 502: Update for Construction Industry May 5-7
           REFRESHER                                   course. Tuition for the DOT Hazardous Materials        sent upon receipt of registration.                          Outreach Trainers
          JULY 15, 2010                                Transportation Refresher course is $175. Tuition                                                                 8-Hour HAZWOPER Refresher                      May 7

                                                       for the IATA Refresher course is $155.                                                                           Chemical Compatibility & Storage               May 10
This one-day seminar is designed to meet the                                                                                                                            OSHA 510: Occupational Safety and Health May 11-14
recurrent training requirements for hazardous                                                                               CANCELATION/
                                                                  4 Easy Ways to Register                                                                                 Standards for the Construction Industry
materials handlers regulation by Department                                                                              SUBSTITUTION POLICY
                                                                                                                                                                        Asbestos Project Designer Refresher            May 12
of Transportation (DOT) Hazardous Materials
                                                       Telephone your registration information to the         If you are unable to attend, a substitution can be        Asbestos Contractor/Supervisor Refresher       May 13
regulations. Under DOT, refresher training is
                                                       Course Coordinator at 801-581-4055. Payment            made at any time without charge. Refunds, less a          Asbestos Worker Refresher in Spanish           May 15
required every three years for hazardous mate-
                                                       or purchase order should follow within two weeks.      $50 administrative fee, can be issued on request          OSHA 500: Trainer Course in Occupational May 18-21
rial employees that select or fill packages, label
containers, fill out shipping papers, load or unload                                                          for all cancellations except those postmarked or            Safety and Health Standards for the
                                                       Fax your completed registration form, followed         faxed within 10 business days of the course, for            Construction Industry
cargo vehicles or containers, operate transpor-
                                                       by payment or purchase order within two weeks.         which no refunds or credit will be given. In the          Transportation of Dangerous Goods:             May 25-27
tation equipment, or at responsible for the safe
                                                       FAX: 801-585-5275.                                     case of course cancellation by RMCOEH, the
transportation of hazardous materials (including                                                                                                                          Compliance with IATA
hazardous waste).                                                                                             Center's liability is limited to the full refund of the   International Air Transportation Association   May 28
                                                       Mail completed registration form with check or         course fee.                                                 (IATA) Refresher Training
                                                       company purchase order to the address on the
                                                                                                                                                                        Asbestos Inspector Refresher                   May 28
                                                       reverse side. You are considered registered
                                                       when full payment or a purchase order has been                                                                     (Green River, WY)
                                                                                                                          TUITION ASSISTANCE
      INTERNATIONAL AIR                                received. If you expect payment delays, send                                                                     OSHA 503: Update for General Industry          June 2-4
    TRANSPORT ASSOCIATION                              completed registration form now and your pay-          These programs were developed with support                  Outreach Trainers
            (IATA)                                     ment within two weeks.                                 from the National Institute for Occupational              8-Hour HAZWOPER Refresher                      June 7
          REFRESHER                                                                                           Safety and Health (NIOSH), Centers for Disease            OSHA 511: Occupational Safety and Health June 8-11
         JULY 16, 2010                                 ONLINE registration (         Control and Prevention, Public Health Service,              Standards for General Industry
                                                       rmcoeh/ContEdProg/2010courseschedule.htm)              US Department of Health and Human Services.               OSHA 2225: Respiratory Protection              June 9-11
                                                       is available; payment must follow within two           Partial tuition waivers are available to personnel        40 Hour HAZWOPER Training                      June 14-18
 This course serves as a refresher for those
                                                       weeks.                                                 from state, and local health and environmental            OSHA 501: Trainer Course in Occupational June 15-18
 who have already completed the initial IATA
                                                                                                              agencies needing training related to hazardous
 training. IATA requires refresher train-                                                                                                                                 Safety and Health Standards for the
                                                                                                              substances response. Please complete the en-
 ing every two years. The refresher course                                                                                                                                Construction Industry
                                                                           CREDIT                             closed form if you wish to submit a tuition waiver
                                                                                                              request for consideration.
                                                       These courses will be awarded Continuing Edu-
	 review of the key aspects of the initial            cation Units (ceu's), the national standard for rec-                                                                       VISIT OUR WEB SITE FOR
  course                                               ognition of non-university professional education.            PRIMARY COURSE FACULTY                                      MORE TRAINING COURSES
	 update of the key aspects of the initial            ABIH CM points have been requested.
  course                                                                                                      Mark Dumas, MSPH, Sage Safety Services                    
	Changes in federal & state regulations                                                                                                                                        ContEdProg/2010courseschedule.htm

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