Please Fill out this Form to sign up for a class or certification session.  Type your full
name so we know who sent the form (Incomplete forms will be discarded).  Please
make any necessary arrangements to attend classes or certifications that you sign
up for.  CPR/First Aid is a two step process: sign up for  the class you wish to attend
far enough in advance to finish the online portion which takes about 2.5 hours.  
IBEW Local 196 members please use the Local Hub app to register for classes!!!!!
Class/Cert.
Sign-up
Form
Calendar of Classes
and Certification
Sessions
Full Name:
Ticket Number:
Classification:
E-Mail Address:
(That you Check)
Mobile or
Home phone:
Class your
signing up for :
Date of class you are
registering for :        
Format: MM/DD/YEAR
If you listed a mobile phone do you agree to receive text
messages on it from the Safety and Education Fund?
YES
NO
If you have an E-mail do you agree to have correspondence sent
via e-mail?
NO
YES
Home Address
Street
City
State
Zip Code
Mailing Address if Different than HOME
Street
City
State
Zip Code
Please check and make sure everything is complete and correct.  
Notes or other Info:
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