Registration/Application Request

Privacy Act Statement Title 5 US Code, Section 301; Executive Order 9397 authorizes the use of your Social Security Number as an identification number. The purpose of this information is for recordkeeping and notification of related training presented by this Center . Having read the preceding Privacy Act Statement submission of this electronic form indicates applicants consent.

In order for you to get your password and on-line instructions, you MUST fill in all the fields on this form and be within the 90 day window prior to your expiration date.

Transport of Biomedical Materials Refresher On-Line Training

Fields marked with a red * are required. Use the TAB Key to navigate from field to field.

*Name (Last, First):    *Job Series/AOC:    *Grade/Rank:

*Job Title:           Component: Army, AF, Navy, C-Gvt, N-Gvt, Etc:

Gender:    Male    Female

Complete Current Office Mailing Address:

DSN Phone Number:                        Commercial Phone Number:                        Comercial Fax Number:

AKO E-Mail Address :                        *Work E-Mail Address

It is necessary for the applicant to have verbal supervisory approval before submission of this form.

Supervisor's Title & Name:                        Supervisor's E-Mail:                        Supervisor's Phone Number: