Ft. Wayne Registration Information
  1. Sponsored by:
    Shambaugh & Son, LLC

    Conducted by:
    Industrial Consultants, LLC

    8 hr Emergency Response Refresher
    February 5th, 2018
    $325.00 each

    24 hr Emergency Response
    February 7-9, 2018
    $715.00 each

    Fit Testing
    $40.00 each

    Class location:
    Shambaugh & Son
    7614 Opportunity Dr
    Ft. Wayne, IN 46825

    For more information contact:

    Industrial Consultants, LLC
    Phone: 918-274-8639
    Fax: 918-274-8816

  2. 1) Full Name*
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  3. Choose your class*
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  4. Date*
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  5. 2) Full Name
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  8. 3) Full Name
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  11. 4) Full Name
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  14. *** PLEASE NOTE: If you have chosen to be Fit Tested***
    Due to many different varieties of masks, you will need to bring your own mask along with HEPA Filter.
  15. In order to wear a respirator / SCBA during the hands-on scenario exercises of the Emergency Response & Respirator Training you must provide written documentation stating that you are approved to wear a respirator / SCBA according to OSHA guidelines in 1910.134 Appendix C.

  16. Company Name*
  17. Contact*
  18. Billing Address *
  19. Billing City*
  20. State*
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  21. Zip*
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  23. Phone*
  24. Fax
  25. Email*
  26. PO Number
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  27. Payment Options
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  28. Comments
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  29.   

  30. CANCELLATION POLICY
    Industrial Consultants reserves the right to cancel any course due to insufficient enrollment. Students enrolled in a cancelled course are entitled to a full refund or the payment may be transferred to another course. If you choose to withdraw from a course, you must do so no later than 15 days prior to the course start date. No refund will be made if a student drops the course after this time. If you fail to cancel and do not attend the class, you will be responsible for the entire cost of the class. A person who is registered and is unable to attend, may at no additional fee, send a substitute.