Registration Form – English


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Earth Environmental Consultants LLC

11 Norden Place, unit 14, Norwalk, CT 06855; Tel: (203) 831-8911, Fax: (203) 286-7997

Office Location: 124 Tesiny Avenue, Bridgeport, CT 06606

E-Mail: earthenvironment@aol.com 

**See back of page for Pre-requisites for Asbestos & Lead Training Refresher

TRAINING REGISTRATION FORM

  • Registration should be submitted 7 days before training to guarantee a place in the training (This is only applicable if informed as a prerequisite, otherwise disregard.)

  • Clearly print ALL information below since it will be used to prepare your certification.

  • To reserve a seat 50% down payment is required 10 business days prior to the training. 

  • Full payment is required to guarantee a seat in the training and to receive a certificate of completion if the training is successfully and fully completed. 

  • Cancellation must be done in written 3 business days before class’s date to obtain payment refund. (This is at the discretion of the company)

  • All decisions with respect to changes of training policy requirements, attendance, prerequisites, payment, if any, will be at the sole discretion of the company.

  • EEC reserves the right to deny any student attendance into the class at any period of time.



Name of Course
Date of Course
date_range
First Name
Last Name


Date of Birth

Address
City
Zip Code
Home Phone (include area code)
Cell
Company Name
Address Work
City
Zip Code
Work Phone
Fax



REQUIREMENTS FOR REFRESHER TRAINING:    

  1. Students must submit copy of initial training certificate, latest refresher training certificate, and current CT DPH License - only applicable for Asbestos & Lead.

  2. New students must submit full history record of his/her trainings and copy of the current CT DPH License- only applicable for Asbestos & Lead.

TERMS & REGULATIONS

 I will always show up on time to class. Late students will not be accepted into class, under  any circumstance, and payment will  not be refundable.   THEREFORE, the student hereby accepts to our terms and regulations. Please sign below.




Method of Payment
SignatureI agree to the terms and conditions
(Sign Here)
Clear Signature
Date
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PRE-REQUISITES FOR ASBESTOS & LEAD REFRESHER TRAINING


For all Asbestos and CT Lead related Refresher Course sign-ups: Registrants must provide Earth Environmental Consultants LLC copy of the initial training certificate, last year’s/most current refresher Training Certificate, and copy of their CT DPH Abatement License for the discipline you want refreshed. Expired training certificates less than one year past expiration date are still recognized for entrance to a refresher class. Expired training certificates more than one year past expiration date cannot be accepted for entrance into a refresher class. Federal and State Agencies require individuals with such expired accreditations to register for an Initial Training Program accredited again. 


IMPORTANT: Please be aware that you will be added to next year’s refresher training. The date selected will be chosen before your current training certificate expires. We will send a group text to everybody who attended and successfully passed the final training course exam as a reminder a minimum of one month in advance. No exceptions unless discussed and approved by Earth Environmental Consultants, LLC. Owner, Mr. Eduardo Meza.  




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