Complete Incident Response Training (Cirt)

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COMPLETE INCIDENT RESPONSE TRAINING (CIRT)

(210) 833-3532

Web Site:

Training Course Registration Form

TDLR Approved Provider # 1620

INSTRUCTIONS: Completeregistration below; please print information clearly.

Completed registrations can be emailed to: or fax to: (210) 592-7239

Date: ______

DriverName: ______

Driver’s License # and State: ______

TDLR Tow Operator License# ______

License Type / Circle One: CT PP IM DUAL

Driver Mailing Address: ______

City: ______State: ______Zip: ______

Phone #: ______Fax #: ______E-mail: ______

Company Name: ______

Company Address: ______

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Select Your Course Below

CIRT 4-Hour CE Course ______$65.00

CIRT 8-Hour IM Course ______$195.00

SHRP-2 / CIRT 4-Hour TIM Responder Course ______** Call for Pricing **

CIRT 8-Hour M/D & Basic Heavy Duty Course ______** Call for Pricing**

CIRT 16-Hour Advanced Heavy Duty Course ______** Call for Pricing**

Course Date: ______Course Location:______

PaymentOption (circle one): Check, Cash or money order. Make payable to CIRT. No Credit Cards

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LIST OF REQUIRED ITEMS TO BE BROUGHT TO THE TRAINING CLASS BY ATTENDEE:

4-Hour CE Course: (1) TDLR License. (2) Texas Driver’s License. (3) Ink pen.

8-Hour IM Course: (1) TDLR License. (2) Texas Driver’s License. (3) Ink pen.

(4) Wear appropriate clothing for hands-on training.

(5) Leathergloves. (6) Safety glasses. (7) Reflective vest.

Please arrive 15 minutes early forcourse check in.

CIRT COURSE REFUND POLICY IS AS FOLLOWS: If a course date is cancelled by CIRT and not rescheduled, all registered attendees will receive a 100% refund of any

pre-paid fees. If cancelled by a registered attendee less than 10 days before the scheduled course date, 33% of any pre-paid course fee will be refunded. If cancelled by a registered attendee more than 10 days before the scheduled course date, 66% of any pre-paid course fee will be refunded. No refund will be issued if the registered attendee is a no-show the day of the scheduled course. All requests for refunds must be made to CIRT in writing by whatever process the student or company used to schedule the course i.e. e-mail, fax, etcetera..... Once a refund request has been received by CIRT, a refund check will be mailed out within 30 business days from the date that request was received. Classes can be cancelled by CIRT for many reasons to include; not meeting the minimum number of students pre-registered prior to the scheduled class date. In case of a cancelled class date, CIRT will make every attempt to notify every student that has pre-registered at least 24-hours prior to the scheduled class date. All pre-registered students will be notified of the rescheduled date for their class.

CIRT instructor(s) reserve the right to require any unruly or disorderly student to leave the class,

if in the instructors opinion, the students conduct becomes a distraction to the class.

If a student is asked to leave during the class, based on the above grounds, there will be no refund of any paid course fees.

Electronic notification to the Texas Department of Licensing and Regulation will be made by Complete Incident Response Training no later than seven days after completion of the course by the attendee.

For additional information or questions call CIRT at 210-833-3532

or go to