Purchase Order Payment Only - Registration Information

District/Agency Name *

Phone Number (Area Code) + (Phone Number) *

Email (This is where a confirmation will be sent.) *

Email - Enter again to confirm *

Mailing Address *

City *

State *

Zip Code *

SELECT DATE/LOCATION: *

NUMBER OF ATTENDEES - Enter the number 0, 1, 2, or up to 15 for the number of attendees in each box.

Quantity:

(Every box requires a number from 0 - 15.)

* 🛈

	Food Manager Class and Exam ($159.00)
	Food Manager Exam Only (No Course) ($109.00)
	Manager "Re-Test" Only (Did not pass previously. Includes class.) ($79.00)

Enter ALL the names of the people attending the class/exam. The number of names should match the total number of attendees in the boxes above. Use the + or - button to add or delete names.
(First Name | Last Name) *

+-

NOTE: Please bring a tablet or laptop computer to take the exam—no cell phones. You may rent a tablet computer, see below.

OPTIONAL PRODUCTS - Enter the number 0, 1, 2, or up to 15 for the number of products in each box.

Quantity:

Every box requires a number from 0 - 15.

	Tablet Computer Rental (To take the exam!) ($10)
	NEHA Spanish Food Safety Management Book (sent via US Mail) $59

COUPON OR PROMO CODE - Coupons are ONLY available for the COURSE AND EXAM, not for exam only or re-test. 🛈

Current Total:

$0.00

Check here to agree to all purchase terms and conditions. * 🛈

Yes

How did you hear about us? *

PO Information

Purchase Order Number (Schools & Govt Only) - We do accept purchase orders from public schools and other government agencies. We will send an invoice via email. Net 30. Enter the PO number below or use "invoice me" if you do not have a PO number at this time.

Optional - Upload a copy of the PO or email to garth@fidelitysafety.com