Pacific Training
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Please complete this form and fax along with a copy of your typical bill of landing.
503-722-9122
REGISTRATION FORM

NAME
REGISTRATION
Company: (required)
 Session date:
Address: (required)
PAYMENT TYPE
  Credit Card: Check:
City: (required)
Zip: (required)

If paying by check please remit to:
Pacific Training
PO Box 16
West Linn, Oregon 97068
If paying by credit card
Please call:
1 (503) 702-3222

(Cancellations received later than 3 days prior to seminar subject to a $25.00 service charge)

State: (required)
Phone: (required)
Fax:
Email: (required)

 


COMPANY INFORMATION

Employee name :
Employee name :
How many employee's to attend:

Which of the following functions do your employees perform:
Waste Manifests:
 
Shipping papers:
Classification:
 
Labeling / Pacarding:
Loading / Storage:
 
Drivers:

Does your company hold DOT exemptions: Yes No

What modes of transportation are used?
Air: Water: Hwy: Rail: Parcels:
Unit size of shipment?
Bulk: Non-Bulk: Truckload: Less than truckload:

Do you ship hazardous wastes?
List waste codes:
 

List the hazardous materials shipped or received, including proper shipping
name, PG and quantities.

PRICING INFORMATION

2 Day DOT/IATA $395.00 (If 3 or more employees $335.00 ea.)

1 Day DOT ground $250.00 (If 3 or more employees $225.00 ea.)


QUESTIONS & COMMENTS


503-702-3222




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