You are signing up to register for the Confined Space Awareness & Safety course through Chautauqua County Emergency Services. Please complete all of the following information.

YOU MUST BRING A SIGNED CHIEF'S AUTHORIZATION LETTER TO THE FIRST CLASS.

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* 1. What is YOUR name?

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* 2. The applicant understands that a "Chief's Authorization Letter" must be presented at the first class?

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* 3. Applicant's Last Name:

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* 4. Applicant's First Name:

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* 5. Best Phone Number to reach Applicant:

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* 6. Applicant's Email address:

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* 7. Applicant's Fire Department:
(LEO - choose 'Law Enforcement' and specify Department in "other")

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* 8. Is the applicant a Junior member, Venturer or Explorer of the Department:

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* 9. Applicant's Chief's Name:

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