Form Usphs - Vessel Sanitation Program - Centers For Disease Control And Prevention - 2017
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1
22017
Select Requested Workshop (check)
√
DESTINATION
Dates
Form Instructions: Information should be clearly entered. The completed form should be returned
Miami
January 18-20
by email to: cii@gate.net or it
could be printed and returned by mail to the address below.
Miami
April 19-21
USPHS
Miami
May 24-26
Miami
August 2-4
Centers for Disease Control and Prevention
Miami
September 27-29
Miami
November 15-17
Vessel Sanitation Program
Participating Cruise Company Information
Company:
Address:
Street
City
State
ZIP Code
Country
# of Workshop Seats
Phone:
Email Address:
(
)
Authorized
Official (print):
First
M.I.
Last
Signature:
Date:
Participant Information
Job Title*
*First Name
*Last Name
*Ship Name
□
□
Technical or
Operations
□
□
Technical or
Operations
□
□
Technical or
Operations
□
□
Technical or
Operations
□
□
Technical or
Operations
□
□
Technical or
Operations
□
□
Technical or
Operations
□
□
Technical or
Operations
□
□
Technical or
Operations
*
Required information.
Companies with additional submissions should email
cii@gate.net
with a listing providing the same information, as above, either as an Excel or Word file.
Emergency Contact Information
Full Name:
(print)
First
Last
Primary Phone:
(
)
Email
Alternate Phone:
(
)
Address:
Return Registration to: The Cruise Industry Institute
Phone: 407-271-4286 | Direct: 407-808-8210 | FAX: 407-286-0850
7881 Canyon Lake Circle, Orlando, Florida 32835 | U.S.A.
Email:
cii@gate.net
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