NORTHSHORE TECHNICAL COMMUNITY COLLEGE - MSHA 48 (AUG 2026)

Please provide the information requested below. This information will be used to register the employee in the training.

Employer Name
Employer Contact Name
Employer Contact Phone Number
Employer Contact Email
Complete the following information for the employee who is enrolling in the class.
Employee Last Name
Employee First Name
Email Address
Phone Phone - ### - ### ####
Street Address
City
State
Zip Code
Parish
Country
ARE YOU A U. S. CITIZEN?

ARE YOU A U. S. CITIZEN? YES NO
Residency

Residency R-Louisiana resident O-Out of State
Date of Birth Date of Birth / MM / DD YYYY
Social Security Number
Gender

Gender Male Female
Race/Ethnicity

Race/Ethnicity American indian or Alaska Native Black or African American Caucasian/White Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino
SELECT THE TRAINING BELOW:
Part 48 Class location-231 West Cornerview Street, Gonzales, LA 70737

Part 48 Class location-231 West Cornerview Street, Gonzales, LA 70737 Part 48 New Miner 3-day (August 10-12, 2026) 7:30am - 4:30pm Part 48 New Miner 3-day (August 24-26, 2026) 7:30am-4:30pm Part 48 Annual Refresher 1-day (August 13, 2026) 7:30am - 4:30pm Part 48 Annual Refresher 1-day (August 27, 2026) 7:30am-4:30pm
IMPORTANT INFORMATION
Cost of training Part 46 New Miner: $300.00 Cost of training Part 46 Annual Refresher: $100.00 Cost will be invoiced to employer. SPECIALIZED TRAINING IF NONE OF THE ABOVE DATES WORK FOR YOU AND YOUR WORKFORCE, PLEASE REACH OUT TO US AND WE WILL DO EVERYTHING WE CAN TO ACCOMODATE WHAT WORKS BEST FOR YOU! THIS INCLUDES SETTING UP TRAININGS ON SITE IF NEEDED. Please call Robin Sharkey at 985-545-1707 to inquire about a specialized date.

NORTHSHORE TECHNICAL COMMUNITY COLLEGE - MSHA 48 (AUG 2026)

NORTHSHORE TECHNICAL COMMUNITY COLLEGE - MSHA 48 (AUG 2026)

Complete the following information for the employee who is enrolling in the class.

SELECT THE TRAINING BELOW: