REGISTRATION FORM

FREE* 30-Hour Accident Prevention Certificate
Awareness Program
Presented by N.C. Industrial Commission Safety Education Section

October 27-31, 2008
at the
North Carolina Zoo
4401 Zoo Parkway
Asheboro, NC 27205

 


 

INSTRUCTIONS: Fill out and click the Send E-mail button below to send in the following form.  Your email server will open with a new email.  Click send within your email program to submit the registration.  
 

 

E-MAIL REGISTRATION FORM FOR 30-HOUR APCAP

First Name:                                

Last Name:               
 

Position:                   
 

Company:                 
 

Address:                    
 

City:                                State:       ZIP: 

Phone:                  

E-mail Address:        
 

   Please check box to be added to e-mail list.

Note: The Quality Inn Asheboro is offering a rate of $63.75 per night, plus tax, for the Asheboro APCAP.  Please make hotel reservations directly with the Quality Inn Asheboro, 242 Lakecrest Road, Asheboro, NC 27203; (336) 626-3680. When making reservations, please mention NCIC, which is the Promotion Code for special room rates!  Rate cut off is September 27, 2008.

*$4.00 per person cost to cover defensive driving
course book is payable at the workshop.

N.C. Industrial Commission ·   Safety Education Section
4339 Mail Service Center ·   Raleigh, NC 27699-4339
Telephone: (919) 807-2603 ·   Fax: (919) 715-0282
NCIC Home Page: http://www.comp.state.nc.us/