HAZWOPER 40 Registration

To register for our upcoming HAZWOPER 40 Training, please complete the form below.

Questions? Please call (856) 422-3872 or email info@dvsconline.org

Name*
First Last
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Contact Email*
Fax
Phone*
Extension
Select a Course Date*
How will you be paying?*
Payment by Credit Card:
Type of Card
- American Express
- Mastercard
- Visa
- Discover
Card Number

xxxx-xxxx-xxxx-xxxx
Exp. Date

mm/yy
Security Code
Name as it appears on card
Credit Card Billing Address
Street Address Address Line 2 City State ZIP Code
Signature of Card Holder
Payment by Purchase Order
Purchase Order Number
How did you hear about this training?*
If other, please specify
Total
$0.00

TERMS AND CONDITIONS:

COURSE FEES:
Enrollment is not guaranteed until full payment is received. You will be placed on a waiting list if your registration form does not include payment.

METHOD OF PAYMENT:
Payment shall be made in one of the following methods:

1. Credit Card (American Express, Discover, MasterCard, VISA)
2. Purchase Order (copy must accompany registration form)

PLEASE NOTE:
A 3% convenience fee will be charged on all credit card transactions.

NOTIFICATION FOR CANCELLATION OR CHANGES:
DVSC reserves the right to cancel any class or make other changes in course content, schedule or facilities. Every effort will be made to provide prompt notification of any cancellation or other changes pertaining to course content, schedule or facilities.

Our Partners

CONTACT DVSC

510 Heron Drive

Suite 210

Swedesboro, NJ 08085;

Main Line: 856.422.3872 (DVSC)

Email: info@dvsconline.org

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