Breath Alcohol Testing Refresher Registration Form

Intoxilyzer 9000 Recertification Training

PLEASE NOTE: STUDENTS MUST POSSESS A VALID OR EXPIRED INTOXILYZER 9000 PERMIT WITHIN ONE YEAR OF EXPIRATION TO BE ELIGIBLE FOR THIS CLASS.

THANKS,

CHRIS TILSON

MANAGER, IMPLIED CONSENT

GBI-DOFS

Student's Last Name (required)

Student's First Name (required)

Student POST OKEY

This is the number assigned to the officer to track POST training credit. It should be a O or C followed by six numbers.

Agency (required)

This should be the agency with whom the student is currently employed.

Student Permit Number

This is the current Intoxilyzer Operator Permit number assigned to the student.

Contact Name (required)

Please enter the name of the primary registration contact. This is the person who will be contacted with all registration communications. It is usually the student or the agency's training officer.

Contact Number (required)

This is the phone number we will use should any need to contact the student regarding changes in class status arises.

Contact Email (required)

This is the email to which the registration confirmation will be sent. It is also the primary contact method for all changes in registration status should they occur.

Class Dates (required)

First Available

Check this box if you would like the first available class assigned to the student given the requested class is not available.

Breath Alcohol Testing Refresher Registration Form

Intoxilyzer 9000 Recertification Training

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