Registration for Medical Gas Training Seminar Please fill out a separate form for EACH student. "*" indicates required fields Red Lion MedGas Consultants, Inc.Registration for Medical Gas Training Seminar* ASSE 6005 Medical Gas System Specialists ASSE 6010 Medical Gas Systems Installer ASSE 6020 Medical Gas Inspector ASSE 6040 Medical Gas Maintenance Personnel Class start date* Name of Student* First Last Nickname Address of Student* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Work PhoneHome or Cell Phone*Email* Social Security Number (Last 4 Digits)* Experience Level* Master Plumber Journeyman Apprentice N/A Years Experience* Job Title* Field Supervisor Inspector Estimator Other In-house hospital personnel (please specify) Current METC License Number (if any) States Do you currently work on medical gas pipelines?* Yes No Are you familiar with NFPA 99?* Yes No Name of Employer* Company Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Company Phone*FaxAcknowledgements* I certify that I have been involved with the mechanical trade for four years.
