Form Registration

FORM INFORMATION

Do you want to receive an email confirmation about today's registration? *

Yes

Email address to send confirmation: *

CLASS INFORMATION
Course: OSHA 7115 - Lockout/Tagout (127115)
Location: Alliance Safety Council - Gonzales, LA - Room 101
Date: 4/26/2018
Time: 8AM

CLASS COSTS
Price of Class: Call for Price

LOCATION INFORMATION
Alliance Safety Council - Gonzales, LA
Address: 1205 West Edenborne Parkway
City, State, Zip: Gonzales, LA 70737
Phone: 225-282-3330
URL: https://www.google.com/maps/dir/''/alliance+safety+council+gonzales+louisiana

We are located within the Edenborne development at Interstate 10 and Highway 44.

CLASS INFORMATION

Daytime classes typically start at 8 am CST.

Night and weekend classes typically follow the schedule below.

Sunday: 1:30 pm - 6:30 pm CST
Monday: 6:00 pm - 10:00 pm CST
Tuesday: 6:00 pm - 10:00 pm CST
Wednesday: No class
Thursday: 6:00 pm - 10:00 pm CST
Friday: 6:00 pm - 10:00 pm CST
Saturday: 8:00 am - 5:00 pm CST

*Class schedules are subject to change.

STUDENT INFO

Registration: Registration forms for non-trainer courses must be submitted at least 5 calendar days prior to the start date.

First Name (Legal): *

Last Name (LegaL): *

Company Name: *

Please provide the mailing address to which course materials should be mailed.

Mailing Address : *

City: *

State:

Zip: *

Country: *

Cell Phone: *

Permanent Email: *

DOCUMENT UPLOAD

Prerequisites: none

Virtual Classes Only: You must reside or work within Region VI (Arkansas, Louisiana, New Mexico, Oklahoma, or Texas) to attend a virtual class. If you are registering for a virtual class, a photo or scan of your Government-Issued ID or letter from your employer must be uploaded with this registration to verify your residence.

Government-Issued ID or Letter from Employer:

Document Name

PAYMENT OPTIONS

Cancellations:

Cancellations received by noon two business days prior to the first day of class will receive a full refund.
Cancellations received after noon two business days prior to the first day of class will not receive a refund but may be eligible for a transfer.
No call, no show students will not be eligible for a refund or transfer.

Cancellations should be made by phone to 877-345-2515 or by e-mail to info@midsouthoti.org. Refunds can take up to 10 business days. Appeals to refund decisions can be made by e-mailing info@midsouthoti.org.

Please note: In the event that MidSouth cancels a course, students will receive a full refund.

Promo Code:

Document Name (Leave Blank to use File's Name):
Document:
	File can only be 5MB or less in size.

Okay to process with the following prices?:
First Student:
Second Student:
Third Student:
Fourth Student:

Confirmation Email:

CLASS INFORMATION
Course:
Location:
Date:
Time:


STUDENT INFORMATION
First Student ID:	Cost:	Balance:
Second Student ID:	Cost:	Balance:
Third Student ID:	Cost:	Balance:
Fourth Student ID:	Cost:	Balance:


PAYMENT INFORMATION
Payment Type:	Credit Card	CC Type:	CC Number:
First Student Payment Amount:		Payment Date:	Transaction ID:	Authorization Code:
Second Student Payment Amount:		Payment Date:	Transaction ID:	Authorization Code:
Third Student Payment Amount:		Payment Date:	Transaction ID:	Authorization Code:
Fourth Student Payment Amount:		Payment Date:	Transaction ID:	Authorization Code:


LOCATION INFORMATION

Address:
CSZ:
Phone:
URL: