Contractor/Supervisor Refresher Class January 28, 2026

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Registration Form

Email *

First Name *

Last Name *

Address *

Phone number (Cell) *

NYS Driver's License Number (Write entire number) *

Employer *

Employer Address

Employer Phone Number

Employer Contact Person

Email Address, Contact Person *

Date of last initial or refresher course *

YYYY

Where did you take your last initial or refresher course? *

Training Class - Price *

January 26, 2026 - Contractor Supervisor Refresher: $160.00

Do you want Alpine to send your certification paperwork to NYS Department of Labor?

Yes, send in NYS DOL certification paperwork - DOL fee $75.00 plus $25.00 ALPINE processing fee ($100.00 Total)

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Payment Options *

Self Pay: Cash

Self Pay: Check

Company Pay: Check

Company Pay: Credit Card

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