Please enable JavaScript in your browser to complete this form.First Name *Last Name *Organization *Phone *Email *Course TitleCourse DescriptionType of coursePre-recorded videoLive Video2 part, online and Hybrid (In-person hands-on)Hands on Course Description, describe the hands-on portion, location where the class will be held, how many students can attend . (keep in mind that onsite training will be up to you and students will have to travel to your location.)Can we add your course to our library for students at a later date? YesNoCan your live course be recorded and made available for students at a later date? YesNoDo you have another class to submitNoYesTo add another course please go back to hazmat.org and start a new form.Course Length8 Hours4 Hours2 HoursOther please specify belowIf Other, Please SpecifyCan students contact you for informaiton?Yes by EmailYes by PhoneNoEmail *Phone *Additional Comments______________________________________________________________________________________________________________________________________________________Submit
