COURSE REGISTRATION FORM ENGLISH REGISTRATION FORMFirst NameLast NameAddress Line 1Address Line 2 (Optional)CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePhone NumberCompany Name or N/AName of Student Attending Training (Only if different than above)*Email (Student Attending Training)Select Your Initial Course Date & Location To Attend DOT Compliance Manager (8/25 - 8/26 : Midland College) DOT Compliance Manager (9/8 - 9/9 : Laredo, TX) DOT Roadside Inspection (9/22 - 9/23 : San Antonio, TX) DOT Compliance Manager (9/29 - 9/30 : Midland College) DOT General Hazardous Materials (10/1 - 10/2 : Midland College) DOT Roadside Inspection (10/13 - 10/14 : Laredo, TX) DOT General Hazardous Materials (10/20 - 10/21 : San Antonio, TX) DOT Compliance Manager (11/10 - 11/11 : Midland College) Commercial Vehicle & Brake Inspector Certification (11/12 - 11/13 : Midland College) Commercial Vehicle & Brake Inspector Certification (11/17 - 11/18 : San Antonio, TX) DOT Compliance Manager (12/8 - 12/9 : San Antonio, TX) DOT Roadside Inspection (12/10 - 12/11 : San Antonio, TX) DOT Compliance Manager (1/13 - 1/14 : Midland College) DOT Compliance Manager (1/19 - 1/20 : San Antonio, TX) DOT Audit & Compliance Review Workshop (2/16 - 2/17 : Midland College) Motor Carrier Crash Response & Investigation (2/18 - 2/19 : Midland College) Motor Carrier Crash Response & Investigation (2/23 - 2/24 : San Antonio, TX) DOT Compliance Manager (3/16 - 3/17 : Midland College) Commercial Vehicle & Brake Inspector (3/18 - 3/19 : Midland College) DOT Compliance Manager (3/23 - 3/24 : San Antonio, TX) Commercial Vehicle & Brake Inspector (3/25 - 3/26 : San Antonio, TX)Pay for Course Registration Fee - $1450 (Includes annual training program membership) *Optional Add-On : DOT Annual Phone Consultation - $1500Pay with CardPlace Order
