EmailMe Form - Certification Prep Class Registration Form

REGISTRATION INFORMATION

Prior to registering for classes, attendees are required to have an IMSA Membership ID number. Visit www.imsasafety.org for more information on becoming a member. All certification exams will be located on the attendee's login profile. Therefore, requiring them to access their IMSA account on www.imsasafety.org. Attendees shall verify their account login prior to the class. It is highly recommended that they bring a laptop or tablet to access the exam at the training facility, otherwise, they will have until 11:59 pm on day 2 of the course to complete their exam. There will be public Wi-Fi available at all facilities.

PAYMENT OF FEES
Registration shall be paid in full prior to the first day of class. Invoices will be sent out the end of each week. Please contact bramirez@cityofclovis.org with any questions.

NO SHOW AND CANCELLATION POLICY
Students who do not keep their appointments or provide in writing a notice of cancellation less than 14 days prior to the first day of class will be subject to: NO REFUND or CREDIT OFFERED.

REGISTRATION CLOSE DATE
Registration close date indicates that we no longer accept registrations; submissions received after registration close date will be placed on our cancellations list. There is no guarantee that you will be called to attend the class if that is the case. No exceptions will be made.

CHALLENGE EXAMS
Please contact the bramirez@cityofclovis.org to schedule a Challenge Exam. Exams will be done online using the IMSA International testing platform.

Select class you wish to attend *

In order to check your membership status log into your profile at www.imsasafety.org.

Tell us if you are taking the certification class, challenging the exam or retaking an exam within 12 months of initial full certification class. *

Certification Class

Audit Only

Challenge Exam

STUDENT INFORMATION

Name *

First Last

Email *

Phone *

### - ### - ####

IMSA Membership Number *

An IMSA Membership ID number is required. If you are unsure of or you do not know your membership number, contact IMSA International's Membership Coordinator at (321) 392-0500 to obtain it.

BILLING/MAILING INFORMATION

This is where your certification will be mailed to.

Agency or Company Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Supervisor's Name *

First Last

Supervisor's Email *

Registration confirmation email will be sent to your supervisor.

Billing Email *

Make sure this email is valid. Billing information will be sent to this email address.

TRAINING ROOM LOCATION INFORMATION

Associated Builders & Contractors
2821 Broadway Blvd NE
Albuquerque, NM 88101

Name

First Last