Arizona Mine Inspector - Training Registration
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1
2
3Arizona State Mine Inspector
1700 W. Washington Street, Suite 403
Phoenix, AZ 85007
Office: 602-542-5971
Fax: 602-542-5335
NOTE: The Education and Training fees are dependent on the Federal MSHA grant allocation. Current
fee rates cannot be guaranteed for future classes.
PLEASE TYPE IN ALL DATA
Company/CO-OP
For information on Mine Safety and Health Administration (MSHA) training classes see Arizona State Mine
Inspector (ASMI) web site at
or call 602-542-5971. For information on program guidelines,
fees, cancellation and refund policies see: E&T Fees & Policies Document.
ASMI conducts separate 8 hour Annual Refresher and 24 hour New Miner Inexperienced sessions.
Note: Annual Refreshers are not combined with New Miners.
For individual registration or to register multiple participants in a CO-OP class please submit one (1) month in
advance or sooner. Fill out all pertinent information, class location requested and number of participants.
Please submit a new form for each request.
The Education and Training department will contact you with confirmation or for other available class date(s).
Request training for:CO-OP Class – Individual or multiple registrants in (select location below):
Date of class:
Flagstaff
Phoenix
Tucson
Other ____________________
NOTE: CO-OP registrant for Part 48/46 New Miner Inexperienced/Coal (NMI) available upon request. Special
guidelines must be met. Contact Frank Rabago, Training Manager for information.
Company Information:
Name:
Contact Person:
Mailing Address:
City
State
Zip Code
Phone Number
Email
MSHA ID #
STATE ID #
Metal
Aggregate
Coal
Other
Surface
Underground
Contractor
Number of Employees
1-19
20-49
50+
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