Free F207-195-000 Self Insurance Training Course Registration - Washington

MAIL COMPLETED FORM TO:
Department of Labor and Industries Self Insurance Section PO Box 44890 Olympia, WA 98504-4890 Fax: (360) 902-6977 Use this form to register for L&I self insurance courses only. Please complete a registration form for each participant. Course Information Course Title: Course ID: Date ­ 1st choice: Date ­ 2nd choice:

Self Insurance Training

Course Registration

Check here if you have a disability and require special accommodations to access this event. Please register at least two weeks in advance. Registrations are taken on a first come, first served basis. If your choices are already full, you will be placed on a waiting list. Participant Information Name: Department-approved claims administrator? Mailing Address: City, State and Zip Code: Phone Number: Company Name: Work location: Confirmation of registration will be sent via e-mail. Attendees will receive certification of attendance. For more information, please E-mail us at [email protected]. E-mail Address: Yes No

RESET
F207-195-000 self insurance training course registration 04-2008