Class Registration Form

All courses comply with OSHA Regulations and are instructed in accordance with prescribed training procedures. Completion cards are mailed within 30 days.

  • Please fill in all information completely to ensure proper credit and record keeping.
  • Complete one form for each student attendee.
  • Payment by check is due prior to the start of class on the first day.
  • Attendance is required for the duration of the class to receive credit for completion.
  • Mail checks to:
    Marilyn Stieneke
    Paragon Safety Group, Inc.
    PO Box 37397
    Raleigh, NC 27627

Student Name:

Mailing Address:

Contact Email:

Contact Phone:

Course Name:

Course Date:

All fields are required