Registration Form

2008 Dot Substance Abuse Professional Qualification Training &
The IC&RC DOT/SAP Written Examination

 (Please check the date & location of choice.)

Note: The two day training can be used as a refresher course for the individual who is already a qualified SAP as it meets the DOT/SAP re-qualification criteria for 12 contact hours.   

Training Registration Fee: $295.00. Registration:  8:30 a.m.; Training 9:00 a.m. - 4:00 p.m.
Training includes:  
           Training Manual and Study Guide for IC&RC DOT/SAP Qualification Test
               Continental Breakfast and Refreshments each day
               12 CEU’s Approved Education Credit: EAP's, Counselors & Social Workers
Test Registration Fee: $125.00 · Test Dates in Bold
              Registration: 8:30 a.m.; Testing: 9:00 a.m. - 11:00 a.m. (2 hour limit) 

*Note: Michigan Professionals must register for test through MCBAP. Call 517 347-0891 to register.

Name: _______________________________________________Phone #:________________
Agency: ______________________________________________________________________
Address: _________________________________________ Email:______________________
City: ______________________________________ State: _________ Zip:________________
Training Fee: $295.00 ____ Testing Fee: $125.00 _____Total Amount Enclosed: ________
 ________________________________________________________  / ___________________
Visa/MasterCard Number                                                             Expiration Date
Signature: ____________________________________________________________________
Enclose the registration form with check or Visa/MasterCard number payable to:

Professional Training Center, Inc.
P.O. Box 295 · Marysville, Michigan  48040
Phone: (810) 388-0200      Fax: (810) 388-1342
email Tom Foley: tfa@tir.com

Confirmation Letters with specific location and directions will be sent upon receipt of registration.