Printable Registration Form
You must register in advance and send your information & payment to:
Kentucky Trucking Association
P.O. Box 818
Frankfort, KY 40602
(502) 227-0848 Fax: (502) 227-0849
info@kytrucking.net
Seminar Location:
Whayne Supply - Log Cabin
1400 Cecil Avenue
Louisville KY
Lodging:
KTA Discounted rate: Holiday Inn - Hurstbourne
Motor Fleet Safety Basics – July 22 & 23, 2019
Managing Motor Fleet Safety Programs – July 24 & 25, 2019
Certification Exams – July 26, 2019
____________________________________________________
Name
____________________________________________________
Company or Organization Title
____________________________________________________
Address
____________________________________________________
City State Zip
____________________________________________________
Phone Fax
____________________________________________________
E-Mail
I am applying for…Please Check One:
_______Director (CDS) or _______Supervisor (CSS)
Courses & Certification Fees: Member* Non-Member
MFSB course only (July 22 & 23) _______$480 ________$580
Both courses & certification exam _______$1095 ________$1295
Both courses (no certification exam) _______$880 ________$1080
Testing Option, MMFS course (July 24 & 25) & exam (July 26) _______$995 ________$1195
Certification price above includes course fees, NATMI membership, certification application fee and certification kit.
*Members of NATMI or KTA
NATMI Membership: ________ $250/year
(Seminar discount, professional certifications, mentor program, networking opportunities, newsletters)
KTA Membership: ________ $300 Carrier (plus $10/truck: # of trucks_________) = $___________
_________$500 Allied
Yes, please send membership information to the above address.
All Fees for Seminars Must be Paid in Advance
Total Enclosed / Charge amount = $__________________
Check is enclosed or Credit Card number is:
______MasterCard ______Visa ______American Express
_____________________________________________________________
Card Number Expiration Date
_____________________________________________________________
Name on Card
_____________________________________________________________
Billing Zip Code for Card
_____________________________________________________________
Signature
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Cancelations: Registration fees for cancelations received 30 days or more prior to a course can be refunded, less a $50 fee. Cancelations received less than 30 days prior to the course will be refunded, less a $100 fee. No refund for cancelations 5 or fewer days prior to a course (materials have been ordered and sent).While NATMI & KTA makes its best attempt to hold all scheduled courses, occasionally cancelation or postponement is necessary. In such cases, NATMI or KTA cannot be responsible for non-recoverable prepaid travel expenses or fees incurred by a student. Please check course status with NATMI before purchasing airline tickets, etc.
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