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lop <br /> M .$a <br /> "MIO VERTON Safety Training, Inc, <br /> 1�----� P. O. Box 6297, Aloha OR 97007 Carr roll Free:(866) 531-0403 <br /> In Oregon:(503)531-0403 Fax:(503)531-2595 e-mail wava@overttonsafefycom <br /> website:www.overjonsafefy.com <br /> Forklift & Aerial/Scissor Lift Classes <br /> at Pape Material Handling' & Pape Rents <br /> REGISTRATION FORM FOR FUNDAMENTAL OPERATOR TRAINING <br /> Forklih Gaga Forklift&Aerial/sScissor Lift Classes are$80.00 per Person <br /> 8:00 ARA-Noon Both classes together can the same day:$940.00 <br /> Aeriaiiscmor Lift Class Train-the-Tralner Classes aro$795.00 per P®raon <br /> 9.00 PFA-6:00 Pitt <br /> PLEASE NOTE:These sre ciassim-P. v070+mental safety-Iminrng prasentations <br /> Tralr-flea-Trainer class ONILY quipmant specoc orisnta on or evaluation mill not be pro vidsd. Each <br /> 3:00 AAA-6:00 P161 0encge Mli recelve Doccrnnentatirai of f,Its,Training crpon succc sm cornpktion. <br /> Company <br /> Name <br /> Address <br /> City State—L2:z_ Zip <br /> Phone (,5 ) 3y�- 3 s--�� Fax } i <br /> E-mai! <br /> Contact Person <br /> i Class Location: CITY4<--�,7-7 STATE a-.V Class Date: _:5 <br /> Fist ame SS s�c <br /> ,� Last /moo L�� Over 187 as O No <br /> f,FOMIFT ❑AERiALJSCISSOR LIFT ❑OPERATOR p TRABIEt TYPE: ❑New ❑Renewal <br /> If Forklift-Type: ❑warefiouse(Strzigm ice) ❑Hugh Terrain(kticuiated Mast) ®80Th Cost <br /> fL�/t�1/ Last /�C�/% Over 187 ❑No <br /> First Name TYPE. ❑New ❑RaruaNrat <br /> iFT ❑AERIAL- ISSOR UFT' i]OPERATOR ❑TRAINER <br /> if Forklift-Type: Ll Warehouse(Straight Mz¢st) ❑Rough Terrain(Articulated Mst) L]BOTH Cost <br /> Total Cost $ <br /> TO REGISTER -FAX COMPLETED FORM TO: <br /> (503) 531-2595 PRIOR TO THE CLASS <br /> Epurchase <br /> nt Terms:Payment is due at time of class. <br /> orders, lb9aste Card&Vrsa accepted. <br /> cks Payable to:Overton Safety Training. lnc. <br /> Tax iD 20-2386674 <br /> Branch: <br /> For Office Use Only: PSR Name: <br />