Terracon Training Registration Form

Student Name (as it appears on your drivers license, no nicknames)

First NameMiddle InitialLast Name
Upload PDF or Picture of your L&I Asbestos Card

Browse Files
L&I certification numbers begin with ABAW or ABAS. You can upload more than one file if needed. Drag and drop files to this area, or click "Browse Files" to select files to upload from your device. Cancelof
Upload PDF or Picture of your current AHERA certificate to ensure you are eligible for a refresher class

Browse Files
Upload your most recent AHERA Asbestos Building Inspector/Management Planner/Project Designer certificate. Drag and drop files to this area, or click "Browse Files" to select files to upload from your device. You have 12 months after expiration to complete a refresher class. Cancelof
Upload PDF or Picture of your Lead Renovator (RRP) card

Browse Files
Upload your most recent Lead Renovator (RRP) card. Drag and drop files to this area, or click "Browse Files" to select files to upload from your device. Cancelof
Upload PDF or Picture of your Washington State Lead Inspector or Lead Risk Assessor card

Browse Files
Upload your most recent Lead Inspector/Lead Risk Assessor card. Drag and drop files to this area, or click "Browse Files" to select files to upload from your device. Cancelof
Student Mailing Address (L&I will mail your new card to this address)*

Street Address

Street Address Line 2

CityState/Province

Zip CodeCountry
Student Email
example@example.com
Student Phone Number

Area CodePhone Number
Mobile Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Company
Dept/Division
Company Address

Street Address

Street Address Line 2

CityState/Province

Zip CodeCountry
Argus Code
Contact Person (if different from student):

First NameLast Name
Contact Email (if different from student):
example@example.com

Payment Info

Pre-payment is required at the time of registration to hold your spot in class.
Please select one option:

Pre-pay (Note: Procurement cards will not work unless funds have been released by your Accounts Payable Department)Invoice: Select "Invoice" only if your organization has existing invoicing approval. Terracon is no longer accepting new requests for invoicing privileges.
Reference ID/Purchase Order Number

Order Total $

USD

Credit/Debit/Payment Card Information

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Select your class from the dropdown menus below

Payment Info