Food Safety Trainer Directory Request

First Name *

Last Name *

Please select your certifications, credentials, and/or degrees

Job Title

Company/Organization

Street Address *

City *

State/Province *

Zip Code *

Country *

Phone # *

Fax #

Email Address *

Website

Do you want to be included in NEHA Food Safety Training's online trainer directory?

Yes

No

Would you like to be listed on our Trainer Directory page for additional states? *

Yes

No

If you answered "Yes" above, please select up to 3 additional states below; this information will be included in your listing on the National Trainers page (if you do not select any, then your listing will just be posted with your home state address):

Additional State #1

Additional State #2

Additional State #3

If you provide training outside the United States, please enter the State/Province and Country

AGREEMENT TO TERMS: NEHA reserves the right to request supporting documentation from trainers to substantiate requests to be listed in additional states. Trainers requesting promotion in additional states via the National Trainer page MUST be active trainers in those states, and have documentation/client referrals to support same if requested by NEHA. *

Yes, I have requested to be added to the National Trainer page, and have documentation/references to support that I am working actively in the states I have requested to be promoted in.

No, I have NOT requested to be added to the National Trainer page.

Electronic Signature

Search form