COURSE REGISTRATION FORM ENGLISH REGISTRATION FORM Notify First 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)Radio Field 10/20 – 10/21 : DOT Compliance Manager (MIDLAND COLLEGE) 10/27 – 10/28 : DOT Compliance Manager (BAYTOWN) 11/3 – 11/4 : DOT Compliance Manager (ODESSA COLLEGE) 11/10 – 11/11 : Commercial Vehicle & Brake Inspector (MIDLAND COLLEGE) 11/17 – 11/18 : Commercial Vehicle & Brake Inspector Certification (SAN ANTONIO) 12/1 – 12/2 : DOT General Hazardous Materials (MIDLAND COLLEGE) 12/8 – 12/9 : DOT Compliance Manager (SAN ANTONIO) 1/19 - 1/20 : DOT Roadside Inspection (MIDLAND COLLEGE) 2/16- 2/17 : DOT Audit & Compliance Review (MIDLAND COLLEGE) 2/23 – 2/24 : DOT Audit & Compliance Review (SAN ANTONIO) 3/16 – 3/17 : DOT Compliance Manager (MIDLAND COLLEGE) 3/23 – 3/24 : DOT Compliance Manager (SAN ANTONIO) 4/20 – 4/21 : DOT Compliance Manager (MIDLAND COLLEGE) 5/11 – 5/12 : DOT General Hazardous Materials (MIDLAND COLLEGE) 6/8 – 6/9 : DOT Roadside Inspection (MIDLAND COLLEGE) 7/13 – 7/14 : Motor Carrier Crash Response & Investigation (MIDLAND COLLEGE) 8/10 – 8/11 : Texas Instrastate DOT Compliance (MIDLAND COLLEGE)Pay For Course Course Registration - $650Pay with CardPlace Order
