Safety Manager Certification Class

Registration Form

Today’s Date: _____________________

Course Date: Wednesday, April 3, 2013

Course Location: US Foods Sponsored at: Best Western Vineyard Inn, 7600 Southfront Road, Livermore, CA 94551 - This Location is ¼ mile from US Foods

 (Conference Room: Turn Right Past Lobby to Double Metal Doors)

Class – 9:00am – 4:00pm                        Lunch – 12:00pm – 1:00pm

                                                                                                                            

US Foods Customer ID# _________________________(required for discount) $125.00

Fee Enclosed: $ _______________ (Non US Foods Customers $170.00 per person)

PAYMENT MUST BE RECEIVED PRIOR TO THE CLASS DATE TO GUARANTEE CLASS ENROLLMENT

Name: ___________________________________________________

Company: _______________________________________ Title: ____________________________

Address: (no P.O. Boxes please)___________________________________________________

City: ___________________________________ State: ___________________ Zip: ____________

Daytime Phone: _________________ Fax: ________________ Email: ____________________

Make checks payable to Hospitality Consultants of America and mail to

716 Lighthouse Avenue – Suite G, Pacific Grove, CA 93950

English _________            

Mail completed form to Mr. Abraham Wilson,

716 Lighthouse Avenue – Suite G, Pacific Grove, CA 93950

Or

Email Your Registration to mrfoodsafety@aol.com

Telephone: 1-800-953-3822 for inquiries