Required Training Enrollment Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Name *FirstMiddleLastWhich course or courses are you registering to attend? *Course or courses you are attending (Select all that apply)RT Level IRT Level IIMT Level IMT Level IIPT Level IPT Level IIVT Level IVT Level IIUT Level IUT Level IIUT A-scanCR / DDAPipeline IntegrityToFDPhased ArrayAUTRT RefresherUT RefresherAUT RefresherPA RefresherOperator Qualifications / NCCER / VeriforceDate of Birth *Last 4 of SSN *Home Address *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone * Identification UploadPersonal Photo * Drag & Drop Files, Choose Files to Upload This will be used for administrative purposes and record keeping. Please choose a contrasting background and simulate a passport style photograph of yourself. Please do not wear a hat Driver's License * Drag & Drop Files, Choose Files to Upload Do you have a current State / IRRSP Card? *YesNoState Card / IRRSP Card Drag & Drop Files, Choose Files to Upload Attendee Information Most Recent Employer *How many years do you have in the Industry? *Are you traveling from your home address? *YesNoIf No, Enter the location you are traveling FromAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you flying in to the Training Center? *YesNoIf you flew in please make note of that and attach a copy of your receipt. Drag & Drop Files, Choose Files to Upload You can upload up to 4 files. Terms and Conditions Training Center Rules *I hereby agree to the terms and conditions set forth by the International Union of Operating Engineers Local 112 NDE Training Fund. *All Classes Start at 8:00 a.m. Eastern time unless notified prior to class.1. Smoking in designated areas only. 2. No fire arms or weapons of any kind. 3. No profanity. 4. No use of cell phones during class. 5. Proper attire (no shorts, sleeveless shirts pajamas, jogging pants, or inappropriate shirts). 6. Do not spit gum or tobacco in bathroom facilities. 7. Do not leave spit cups, bottles, cans, etc. sitting around. 8. Respect others in your class as well as other classes by keeping voices down. 9. Leave all areas as you found them. 10. Respect all Local 112 and NDE employees. 11. Respect the hotels and hotel staff as they make special arrangements for any one attending the NDE Training Fund classes. 12. Being late to class multiple times will mean dismissal from class.Safety Training Modules *I hereby agree to complete all safety training modules assigned by the Local 112 NDE Training Staff before class ends in order to receive your final travel / expense check and your qualification records to be released to the signatory contractors. Depending on your qualification level and what class you are taking these safety modules could include the following possibilities. *1. HSI. 2. Veriforce. 3. NCCER. 4. CPR.Signature * Clear SignatureNameSubmit
