TRAINEE INFORMATION & ENROLLMENT FORM
Right click and select print.
Trainee’s Personal
Information
Date
today
|
First Name |
MI |
Last Name | ||||
|
Spouse’s First Name |
MI |
Last Name | ||||
|
Home Mailing Address Apt # |
City |
State |
Zip | |||
|
Home Street Address (if different) Apt # |
City |
State |
Zip | |||
|
Home Phone |
Cell Phone |
E-mail Address | ||||
Business
Information (complete this section only if we may place calls, send
mail/faxes to you at work.)
|
Company Name | |||||
|
Business Phone #1 |
Business Phone #2 |
FAX | |||
|
Business Mailing Address |
City |
State |
Zip | ||
|
Business Street Address (if different) |
City |
State |
Zip | ||
1. How will you travel to
2. When will you be arriving in the
3. Where will you be staying while in the
4. While you’re here, we may have to change your training schedule due to rain. If so, as soon as we know,
we’ll call you. Below, please list the number(s) where we will be able to reach you in the late evening or
early morning hours while you’re here. If, at this time, you don’t yet know how we will be able to reach
you, call us with a phone number as soon as your arrangements are finalized.
In case of schedule change, call me at: 1. Ph. # Room # , 2. Ph. #
5. A maximum of four people from the same company may attend the training class together.
Will you be bringing someone to train with you? No Yes, his/her name:
Relationship to you: Employee Business Partner Spouse Other:
6. Training Classes: There is a $100.00 registration fee for the class. If you find you cannot attend and
notify us at least 7 days in advance, the fees will be returned. You may pay the registration fee by check
or credit card. Fee must be received to hold a space in the training class. Please, check one of the
options below:
a. I am enclosing a check for $100.00 to Creative Concrete Coatings.
b. I am including my credit card information below.
Master Card Print name as it appears on card: