CFS TRAINING (MITAGS) CRANE (EXPERIENCED OR INEXPERIENCED), RTG, GENSET REGISTRATION FORM

THE FOLLOWING NAMES ARE SUBMITTED AS CANDIDATES FOR TRAINING AT THE CARRIER-ILA CONTAINER FREIGHT STATION TRUST FUND CRANE TRAINING SCHOOL IN LINTHICUM HEIGHTS, MARYLAND. IT IS UNDERSTOOD THAT THE COMPANY HEREUNDER NAMED WILL BE RESPONSIBLE FOR THE WAGES AND FRINGES OF THESE CANDIDATES AND THAT THE COMPANY WILL BE THE EMPLOYER. WAGES (ONLY) TO A MAXIMUM OF 80 HOURS STRAIGHT TIME WILL BE REIMBURSED BY THE CFS FUND UPON SUCCESSFUL COMPLETION OF THE COURSE.

Type of Training Class

Class Dates

Port

Employer

Individuals

LEGAL FIRST NAME (NO NICKNAMES)	FULL MIDDLE NAME	LAST NAME	SUFFIX (JR., SR., III)	PLANE TICKETS?	STREET ADDRESS	CITY/STATE/ZIP	HOME AIRPORT (IF FLYING)	DATE OF BIRTH	HOME PHONE	CELL PHONE	E-MAIL

Name of Contact Person

Phone

Company/Association

Date

Fax

USMX

CFS TRAINING (MITAGS) CRANE (EXPERIENCED OR INEXPERIENCED), RTG, GENSET REGISTRATION FORM