HAZWOPER Training Registration Form
Health and Safety Training for Workers at Fixed Facilities
Please complete this form to register for a Hazardous Waste training class. Contact Marlene Perez at Marleneperez@berkeley.edu. for any questions or concerns. If you would like to download and complete a paper copy of this registration form, visit http://lohp.org/hazardous-waste/
Course Title *
Course Dates *
e.g. April. 26, 2017
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Your Full Name: *
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Your Job Title/Position: *
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Your Company: *
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Your Mailing Address: *
Include street, city, state, and zip code.
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Day Time Phone Number: *
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Email Address: *
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Language of Instruction: *
CONTACT FOR PAYMENT (Name, Email & Phone Number): *
Please list who we should follow-up with for payment.
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We can only accept Checks and Purchase Orders at this time.

Please make checks payable to: UC Regents

Mail to:
Hazardous Waste Training Program
Labor Occupational Health Program
2199 Addison St., Ste 451
Berkeley, CA 94720-7360

Cancellation Policy: The registration fee (less 25% cancellation charge) is refundable if written cancellation notice is received two weeks prior to course date(s).

For University of California departments no purchase orders will be accepted.

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