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CAOHC

Course Director Certification and Recertification Workshop Registration Form

Friday, November 16, 2018 - Civilian and Military personnel are welcome to attend this course.
Salt Lake City, UT

Submit this form online or print and mail or fax with your payment:

Registration fee due in full (7) seven days in advance of the workshop. Workshop registration fee includes: Continental breakfast, lunch, CAOHC Hearing Conservation Basic Manual and all necessary course materials and handouts.

As a reminder, certification and recertification applications and fees must be received and approved prior to Workshop attendance. Submit the form from the "How to Become CAOHC Certified as a Course Director" or "How to Become Recertified as a Course Director" section on the CAOHC web site.

Cancellation Policy
Seven days prior to the workshop, a full refund, with the exception of a $25 processing fee, will be made to any registrant who must cancel his/her attendance. After 7 days prior to the workshop, no refund will be made. However, the registrant will be given credit toward the opportunity to attend the next workshop.

Attendance Policy
Candidates must be present for the entire course in order to be granted certification or recertification.

Hotel Reservation Policy
Candidates are advised that many hotels require that you book your reservations at least three weeks in advance to get the discounted hotel rate. Check with the hotel on the cutoff date for discount room rates.

Registration Information

 
Name:*
Certification Number
(for Recertifying CDs only):  
Preferred Name on Workshop Badge:
Company:
Address:*
City:*
State:* 
Zip:*
Daytime Phone:*  
E-Mail:* 


I require special accommodations or specific dietary requirements to fully participate. (Describe needs below.)


How did you hear about the workshop?
CAOHC website
CAOHC mailing
OHC course
Other:


Payment Information:

Amount Enclosed:* $375
Payment Type:*
(online orders are payable by credit card only)
Check (must print form and submit with payment to address listed below)
Money Order
MasterCard
Visa
American Express
Name on Card:*
Credit Card Number:*
Expiration Date (MM/YY):*

* indicates required field

CAOHC   555 E. Wells Street, Suite 1100    Milwaukee, WI 53202-3823
Phone: 414/276-5338    Fax: 414/276-2146      info@caohc.org

Application for Certification CAOHC Course Director

Application for Recertification CAOHC Course Director