Quality Safety Services

Quality Safety Services, Inc.® 4242 East Piedras Dr., Suite 109 San Antonio, Texas 78228-1414 Course Registration Form Please print and fill out form Payment by Check: Mail Registration Form and payment to above address. Payment by P.O. or Credit Card: Fax completed Registration Form to (210) 736-0982.
Name of Course:
Date of Course:				Amount of Course:
Name of Attendee (1):
Name of Attendee (2):
Name of Attendee (3):
Name of Attendee (4):
Organization:
Address:
City:		State:				ZIP:
Telephone:		Fax:				e-mail:
Method of Payment
Check Number:				P.O. Number:
Credit Card Type:	VISA		MC		Am Express		Discover
Card Number:				Expiration Date:
Name as Appears on Card:
Card Holder Signature:
E-mail to: qssi@earthlink.net

Internal Office Use
Refund Policy	Canceled by # of Working Days prior to date of course	Amount of Refund Credit
	10+	Full refund credit less $35.00 processing, or credit for next (same) course.
	5-9	50% refund or credit for next (same) course.
	0-4	No refund or credit for next (same) course.
	No refund for No-Shows. If "No-Show", automatic registration will be credited ONLY for the NEXT available same course.

Please print and fill out form