LSE Registration Form

Please use this form to register for the class you wish to attend.

Once you have filled in the appropriate information boxes, please print this form and return it with the training fee. Thank You!

Please provide the following information for the person attending the training course:

First Name

Middle Initial

   
Last Name

       
Organization

       
Street Address

       
City

,

State

,

Zip Code

Work Phone

       
Home Phone

       
FAX

       
E-mail

       

Please indicate which course will be attended (please use a separate form for each class):

Enter the date of the course to be attended:

Please fill this form in on-screen, then print it out using the print function in your browser.

The printed form may be faxed to (715) 234-6004 to expedite our awareness of your intent to attend our class. 

Please include the printed form when sending in the training fee to: 

Lake States Environmental, Ltd. 

PO Box 645

Rice Lake, WI 54868.

Thank You!

Copyright 1998, 1999, 2003 Lake States Environmental, Ltd.
Last revised: August 14, 2003