ࡱ > ? A > bjbj ;$ | | 4 8 H 4 | $ 2 E G G G G G G $ k k R E E ~ 1 0 ! ! ! k k ! : COURSE SELECTION (Select only one): ______ April 10-15, 2016 Advance Tank Car Safety Course (Hazmat Team Members Only) ______ September 18-23, 2016 Tank Car Safety and Rail Emergency Response ______ October 2-7, 2016 - Tank Car Safety and Rail Emergency Response Organization Information (Do not provide individual information): Name: _____________________________________________________________________________ Address: (Please provide official mailing address of your organization) Street: City, State, Zip Code:______________________________________________________________ Phone: Point of Contact: (Chief, Training Officer, etc.) Name: _______________________________________________________________ Email: _______________________________________________________________ Phone: _______________________________________________________________ Please complete this form and email or fax it to: Mark A. Maday Manager Hazardous Material E-mail: HYPERLINK "mailto:mmaday@up.com"mmaday@up.com Fax: 402-233-2227 Submission of this form does not guarantee selection to attend one of Union Pacifics sponsored training programs. All requests for training will be reviewed and then prioritized based on current operational needs, past incidents, and prior attendance to a sponsored training course. A formal invitation will then be sent to the point-of-contact with the number of seats allocated to the organization for that course. The organization is responsible for identifying their representatives that will attend the training. 2016 Training Reservation Request Form: Tank Car Safety and Rail Emergency Response Course Advance Tank Car Safety Course % - . @ b z { ö姛paRaaaRh h CJ OJ QJ aJ h hf CJ OJ QJ aJ h-( hEl 5CJ OJ QJ aJ h hEl CJ OJ QJ aJ h-( CJ OJ QJ aJ h CJ OJ QJ aJ h hf CJ OJ QJ aJ h0 5CJ OJ QJ aJ "h0 h0 5>*CJ OJ QJ aJ h hEl 5CJ OJ QJ aJ h hf 5CJ OJ QJ aJ h hf CJ aJ % & | } W X V ` g ^gd gd