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and send this form with your payment to the address below:
Full Name:
Job Title:
Company:
E-mail address: (e.g.: you@aol.com)
Phone number (with country, city, area codes):
Fax number (with country, city, area codes):
Address:
City/Town:
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Total Payment Received for Safety School:
Send Registration Payments to:
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Eastern Carolina Safety and Health School
ATTN: John Hodge
4506 Gloucester Drive
New Bern, NC 28562
For information: 252-672-7329
Make checks payable to: Eastern Carolina Safety and Health
School
Registration Fee:
$160 for school and dinner--NO REFUNDS!!
Number of guest dinner tickets at $30 each.
Participant ticket included in
registration fee.
$25 discount per person to organizations sponsoring 5 or more participants.
Fee includes materials, refreshments, lunch, door prizes,
certificate, and school t-shirt.
Download
and send this form with your payment to the address below: