NOTE: Written confirmation must be received from Lanier Technical College before applicant is accepted. Billing Information Company Name    Company T.I.N. (Federal tax I.D. #)   IARW Member? YesNo   PO# Address City State Georgia Outside U.S. ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Zip Code Country Contact Information Contact Name   Phone   Fax   Email Select One or More Courses  Courses with no checkboxes indicate NONE AVAILABLE. 1. Industrial Ammonia Refrigeration Level I $1250.00 Jun 13, 2012-Jun 16, 2012; 13 seats available Jul 09, 2012-Jul 12, 2012; 12 seats available Jul 30, 2012-Aug 02, 2012; 12 seats available Aug 13, 2012-Aug 16, 2012; 10 seats available Sep 10, 2012-Sep 13, 2012; 13 seats available Sep 24, 2012-Sep 27, 2012; 13 seats available 2. Ammonia for Non-Operators $495.00 Jul 02, 2012-Jul 03, 2012; 20 seats available 3. Industrial Ammonia Refrigeration Operator I - Spanish Version $1250.00 4. Industrial Refrigeration Operator Refresher $750.00 5. Industrial Ammonia Refrigeration Level II $1250.00 Jul 23, 2012-Jul 26, 2012; 8 seats available Sep 17, 2012-Sep 20, 2012; 10 seats available 6. Industrial Ammonia Refrigeration Level III - Technical $1250.00 Jun 25, 2012-Jun 28, 2012; 7 seats available Aug 27, 2012-Aug 30, 2012; 12 seats available 7. Maintenance & Troubleshooting for Refrigeration Operators $1250.00 Jun 04, 2012-Jun 07, 2012; 4 seats available Aug 06, 2012-Aug 09, 2012; 6 seats available 8. PSM / RMP for Ammonia Operator $995.00 May 21, 2012-May 24, 2012; 6 seats available 9. HAZMAT 8 Hour Refresher $295.00 Sep 06, 2012-Sep 06, 2012; 20 seats available 10. HAZMAT 24 Hour Technician $595.00 Sep 04, 2012-Sep 06, 2012; 20 seats available 11. HAZMAT On-Scene Incident Command $295.00 12. Introduction to Industrial Maintenance $995.00 Jun 26, 2012-Jun 28, 2012; 12 seats available Sep 11, 2012-Sep 13, 2012; 13 seats available 13. Fundamentals of Programmable Logic – Controllers (PLC) $150.00 14. PLC Maintenance & Troubleshooting - Allen Bradley $750.00 Jun 05, 2012-Jun 06, 2012; 7 seats available Jul 10, 2012-Jul 11, 2012; 13 seats available Aug 07, 2012-Aug 08, 2012; 13 seats available Aug 21, 2012-Aug 22, 2012; 13 seats available Sep 25, 2012-Sep 26, 2012; 13 seats available 15. PLC Maintenance & Troubleshooting - Mitsubishi $750.00 16. PLC Maintenance & Troubleshooting - Siemens $750.00 May 22, 2012-May 23, 2012; 13 seats available Registrant Information Registrant 1 First Name   Last Name   Date of Birth   Social Security #   Registrant 2 First Name Last Name Date of Birth Social Security # Registrant 3 First Name Last Name Date of Birth Social Security # Registrant 4 First Name Last Name Date of Birth Social Security # Registrant 5 First Name Last Name Date of Birth Social Security #     Submitting data ....