Feliz Safety Solutions, LLC

Feliz Safety Solutions, LLC

OSHA Enrollment Form

To register, complete this form with payment and submit to

Student Information

Full Name:
Last / First / M.I.
Address:
Street Address / Apartment/Unit #
City / State / ZIP Code
Home Phone: / ( ) / S.S. Number (last 4 digits):
E-Mail: ______
Current Position:

Class Information

Fee

☐ / Private Class $575* / ☐ / Reduced Group Rate for 3 or more students
*Fee includes Text Book, Exam Questions and Answer Sheets *
**Down payment of 25% at time of scheduling is expected

Payment Method

☐ / Cash / ☐ / Money Order
☐ / Check / ☐ / Credit/Debit Card*

Class Dates (Scheduled 30 days out to insure proper understanding of OSHA Safety Terminology)

☐ / Jan-Feb / ☐ / May-June / ☐ / Sept-Oct
☐ / March-April / ☐ / July-Aug / ☐ / Nov-Dec
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