office (312) 491-0081
fax (312) 421-2901

Pre-Registration Form

     If you want to register for "Certified Renovator" training now, please take a moment to fill out the form below. PAYMENT IS REQUIRED IN ADVANCE. Public Health and Safety, Inc. accepts Company checks, Visa, MC and Discover. All the information collected here will be kept confidential. We will not sell, use, or distribute any information you submit. Check the dates on the Training Dates page.

ALL RRP CLASSES MUST BE PAID IN ADVANCE BY CHECK OR CREDIT CARD.

 1) To pay by credit card:                                                                        Call our office at 312-491-0081.

2) To pay by check:   NO Personal Checks  -   Company Checks ONLY     Send Payment to: Public Health and Safety, Inc. at 105 S. Ashland Ave. Chicago, IL. 60607

All RRP Training is first come first served until payment is received.        * There will be a $50.00 charge for date changes after registration.

Please fill in all fields.

 
First Name * Required
     Middle Initial * Required

Last Name * Required
Email Address * Required
Company Name
Office Ph. No. * Required
 Office Fax No.
 Cell Phone * Required
 Address Line 1 *Required Address Line 2
 City, State * Required
 Zip Code * Required
      Professional Affiliation
   xx/xx/xxxx  Training Date * Required
  Training Location: Chicago, Elgin, etc.
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Group Training