Arkansas Transit Training Registration Form

TRANSPORTATION SAFETY TRAINING PROGRAM
OPEN CLASS REGISTRATION FORM

Please complete a separate form for each person attending.

We cannot accurately register you for the class that you have selected if you do not click the submit button at the bottom of this page

Should you have problems with this process, please call us (877) 372-8904

Field marked with * indicates a required field.

Name:	Title:
Agency:
Address:
City:	State: Zip:
Phone: Ext:	Fax:
Cell:	Home Phone:
* E-mail:	Submitted by:

Place:	Arkansas Transit Association Transit Safety & Resource Center 620 West Broadway North Little Rock, AR 72114 View Map
Voice:	(501) 372-8900
Toll Free:	(877) 372-8904
E-mail:	training@arktransit.org

Indicate each class that the person listed above will be attending.

	TOPIC	Materials Fee
	Drug & Alcohol Training for Supervisors Monday, December 8, 2008 1:00 PM - 3:30 PM	$10.00 (Member rate) $30.00 (Non-member rate)
	DHS/Developmental Disabilities Services Transportation Training Thursday, December 11, 2008 9:00 AM - 4:00 PM	$40.00 (Member rate) $60.00 (Non-member rate)
	Child Passenger Safety Monday, January 5, 2009 10:00 AM - 3:00 PM	$0.00(Member rate) $20.00 (Non-member rate)
	DHS/Developmental Disabilities Services Transportation Training Thursday, January 8, 2009 9:00 AM - 4:00 PM	$40.00 (Member rate) $60.00 (Non-member rate)
	Passenger Assistance Monday, January 12, 2009 10:00 AM - 1:00 PM	$10.00 (Member rate) $30.00 (Non-member rate)
	DHS/Developmental Disabilities Services Transportation Training Thursday, February 12, 2009 9:00 AM - 4:00 PM	$40.00 (Member rate) $60.00 (Non-member rate)
	Drug & Alcohol Training for Supervisors Tuesday, February 17, 2009 1:00 PM - 3:30 PM	$10.00 (Member rate) $30.00 (Non-member rate)
	Coaching the Van Driver II Monday, February 23, 2009 10:00 AM - 1:30 PM	$10.00 (Member rate) $30.00 (Non-member rate)

***Non-members are expected to have paid for training prior to class participation***

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