Training Registration - Training

Participant - print clearly

Date:

Last 4 Digits of SSN:

Class Information
Date desired: See Course Schedule from MPC Rep

Name:

1st Choice:

2nd Choice:

Home Address:

City:

State:

Zip:

Location Desired:

Phone Number:

Email Address:

Job Title:

You will receive a CONFIRMATION LETTER shortly after you send this registration to us.
It will include hotel information you may need, map and/or directions to the class location.
There is currently no charge for this class. You are responsible for all hotel and travel costs.
Hotel reservations - You are responsible!
Do not make airline or hotel reservations until you receive a written confirmation letter.

Do you have any health concerns which prohibit you from working with paint products?

YesNo

If yes, what are they?

Participant's Company / Employer

Name:

Address:

City:

Cancellation Notice

State:

Zip:

If you must cancel your registration, as a professional courtesy, please allow five (5) business days prior to the start of class.

Phone Number:

Fax Number:

Press SUBMIT to email the form, FAX it, or forward this completed application to:

PPG Industries, 19699 Progress Drive, Strongsville, OH 44136

Attn: Darlene Stamper dstamper@ppg.com

Phone: (800) 970-2283 Fax: (800) 227-4952

You will receive an acknowledgement notice by fax, along with a map and/or directions and hotel information.

I want to receive product info and updates!


This form must be completely filled out to properly register you for class.