Class Registration: Documentation of Contract Quantities
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Personal Information
Mr.
Ms.
Mrs.
(* The name on the certificate will appear as it is entered on this form.)
First Name
Full Middle Name
Last Name
Date of Birth (mm/dd/yyyy)
Email Address (required)
(* The confirmation letter will be sent to this address.)
Employer Information
Legal Name of Employer
Consultant
IDOT
Local Agency
Agency Type
Address
City
State
Postal Code
Phone Number (e.g. 000-000-0000)
Fax Number (e.g. 000-000-0000)
Event
Please select the event you want to attend.
Select a Class
2/19/2010: Re-Test (2 Hours) - District One (Training Center Classroom) - 16 slots
3/3/2010: Re-Test (2 Hours) - Harry R. Hanley Building, Room 214 - 7 slots
3/9/2010: 3 Day Class - Illinois Center for Transportation Classroom - 6 slots
3/23/2010: 3 Day Class - District Three (Training Room) - 27 slots
Payment Method
Credit Card
IDOT Billing (IDOT Employees Only)
Office Use Only
Registered
Date/Time Received:
Notes:
Rejected
Processed by:
Illinois Center for Transportation
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University of Illinois at Urbana-Champaign
Illinois Department of Transportation