(661) 377-8300

2130 Brundage Lane

Bakersfield CA 93304-2702
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Class Registration Form

This form can be used to sign up for classes taught by CSTC.  Please fill in all applicable blanks.

FOR PESTICIDES:  CLASS PARTICIPANTS *MUST* BRING THEIR ASSIGNED RESPIRATOR TO CLASS, BE CLEAN-SHAVEN, AND BE READY TO HAVE A RESPIRATOR FIT-CHECK PERFORMED.

NOTE: A COPY OF LAWS COVERING PESTICIDE RESPIRATORY PROTECTION CAN BE FOUND HERE.

Your Name
Company
Telephone Number
Mailing Address
Preferred Class Date
Preferred Class Time
Physical Address of Where Class is to be Taught
Location of MSDS Binder at Your Facility
Class Attendees (Please List ALL)
List up to Twenty (20) Chemicals/Formulations for Class Materials

Please list your Company Physician's Information:

Name

Address

Telephone Number

Please list your Company Hospital Information:

Name

Address

Telephone Number

Name of Chemical Supplier:
Telephone Number of Chemical Supplier:

     NOTE: By clicking "SUBMIT", you agree to hold California Safety Training Corporation, its officers and/or officials, employees, and agents free of liability and harmless from any and all damages that may now or in the future arise as a result of the services rendered by CSTC pursuant to this agreement or any and al aspects of the safety programs herein provided. Further, your company agrees to indemnify, defend, and hold CSTC harmless from any and all claims, liabilities, losses, attorney’s fees, damages, or injuries against CSTC and representatives. Further, your company acknowledges that California Safety Training Corporation does not provide legal advice or counseling and therefore is not relying on California practices, labor relations, safety policies or safety procedures. Your company assumes total and complete control, responsibility and liability for the information guidelines, practices, and implementation of your company’s safety program, and employee policies and procedures.