Forklift Safety Training Registration

Todays Date:
Company Name:
Company Address:
Company Phone #:		Fax #:
Company Contact:		Phone #:
Company Contact Email:
Requested Training Date(s):
Type of Training Requested:	Sit Down Narrow Aisle Combo
Location of Training:	Atlantic Lift Company's Location On-site		(if company on-site, please call to complete additional registration information.)
Students can read and write English?	Yes No
Number of Students
List Students (one on each line):
Are there any specific workplace safety considerations you would want trainer to address in training, if yes, explain	Yes No
If yes, please explain:
Are there any considerations physical or otherwise that would limit any students from completing the written or driving portions of the training?
How did you hear about Atlantic Lift Forklift Training?
Cancellation Policy: "No shows" will be charged the full Fee, unless a cancellation is made 48 hours prior to the date of the training. Atlantic Lift Truck, Inc reserves the right to cancel classes if minimum attendance is not met.
Security Code:	Please enter the text as it appears in the image to the right