Form

First name*

Last name*

Email*

Phone number*

Company name*

Birthday*

Day/Month/Year

Day-Month-Year

Street address*

City*

State/Region*

Postal code*

Country/Region*

Location*

Food Intolerances or Allergies*

Preferred Course Date #1*

Preferred Course Date #2*

Referral Source*

Numbers of years of work experience*

Safety Training Course*

Tower Climbing and Rescue

Emergency Contact First Name*

Emergency Contact Last Name*

Emergency Contact Phone Number*

Last Training Date

Day-Month-Year

By clicking this box, you agree to the cancellation policy as listed below.

Cancellations made at least 15 calendar days prior to first day of the Course will be refunded the full amount. If you cancel at least 7 calendar days but less than 15 calendar days prior to the first day of the Course, the deposit will not be refunded but will be kept as credit for future registrations. If you cancel less than 7 days from the first day of the Course, no refunds are issued, nor will you have a credit for a future course. If you drop out or cancel after the Course has commenced, no refunds will be made. If you cannot assess due to your logbook being incomplete, there will be no refund. If you cannot comply with the physical demand of the course and drop out, there will be no refund. If Pacific Ropes cancels the course for any reason that is no fault of the participant, a full refund will be issued.