Customer Location Safety/Application
& Operator Training Class Registration Form

Complete (type or print neatly) this registration form and fax the form to Sky Climber at 740-203-3901.  Indicate the course dates desired, allowing at least one week between 1^st and 2^nd choices.

Training Course Requested Dates:

            Number of days requested:___________________________________________

            1^st Choice (Date): __________________________________________________

            2^nd Choice (Date): __________________________________________________

Customer Information:

            Company Name: ___________________________________________________   

            Address:                                                                                                      

            City:                                                              State:                   Zip:              

            Company Phone:                                            FAX:                                       

            Contact Person:                                                                                            

Training Location (if different than Customer Address):

            Location Name:                                                                                             

            Address:                                                                                                        

            City:                                                              State:                   Zip:              

Payment Method:

                        Company Purchase Order Number:                                                      

                        Charge Credit Card (circle one) - American Express, Visa, Master Card

                        Card or Account No.                                           Expiration Date:              

                        Name on Card:                                                                                          

                       Authorized Signature:                                                                                 

Fax the completed form to Sky Climber at 740-203-3901.