Sky Climber® 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. Select the course dates from the class schedule. Remember, classes fill quickly and reservations are on a “first come,
first serve” basis.
Training Course(s)
Requested Dates:
Number of days requested:
_____________________________________________________
1st Choice (Date): _____________________________________________________
2nd 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: ____________________________________
If paying by check, please
mail a copy of completed form and the check to the following address: