Consumer Education Services
PO Box 724261
Atlanta, GA 31139
(770) 333-7912
(770) 384-1784 Fax

OPTION I
(Please Print)

One-Day Class
(English)

 

OPTION II
(Please Print)

Two-Day Class
(Non-English)

 

Circle the type of class:

 

Date:

 

Date:

 

English

 

 

 

Time:

8:30 AM – 6:30

Time:

8:30 AM – 5:30 PM

Spanish

 

 

 

 

 

Location:

 

Location:

 

Chinese

 

 

 

 

 

 

 

 

 

Korean

 

 

 

 

 

Class Fee:

 

Class Fee:

 

Vietnamese

 

 

 

 

 

(Please fill out registration in English)

Student’s Name:

(Please Print)  ______________________________________________ Home Phone:  __________________

 

 

Address:   (No PO Boxes)

____________________________ City: ____________ County: ____________ Zip: ________

 

 

Food Service Establishment:

  ___________________________________________ Work Phone:  ______________________

 

 

Address:

_____________________________ City: ____________ County: ___________  Zip: ________

 

 

Examination:
(Please indicate with an X)

English: ______ Spanish _____  Korean:  _____  Chinese: ______  Vietnamese: ________

__________  Food safety Class (s) @ $ _____________  each

$ ________________

                      Which includes Advanced mailing of text book

 

 

 

Enclosed in my check, money order (or credit charges)

$ ________________  Total 

 

 

Charge my:   ___  VISA    ___  MASTERCARD  ___  DISCOVER

(Please indicate with an X)

 

 

Card No: _________________________  Exp. Date: ________

Class Option # I       ____________    English

 

 

Card Holder’s Name (Please Print Name)  _____________________

Class Option  #II     ___________     Non-English

 

 

Card Holder’s Signature: _______________________________

 

·      If you send a check or money order, please make the check or money order out to:
Consumer Education Services for the fee amount listed for your class.

·      You will receive a receipt through the mail with your book and study materials..

·         Make a copy of this registration and mail the original back to Consumer Education Services
at the address listed above. If you pay by credit card, you may fax your registration using the
fax number above. If you mail or fax your registration in later than 15 days before a class, you will be charged
an additional $25 to get into the class, if there is room, because of limited seating. Mail registration early
to have enough study time.