FREE SEMINAR REGISTRATION

Instructor First & Last Name*

Select the available seminar*

Your Email Address*

Your Phone Number*

Address

Please enter your address

Employer

This is the school where you teach.

Position

Ex. Agriculture Teacher, Welding/shop teacher, Councilor etc.

What is your welding experience?

BasicIntermediateAdvanced

Have you ever been to the wet welding seminar?*

YesNo

Are you bringing a guest/significant other

Shirt Size

Medical Statement and Questionnaire

By filling of out more than one box does not disqualify you from being a participant

Medical Statement:

The purpose of this medical statement is to inform you of some potential risks involved when participating in the Commercial Diving and Industrial Inspection seminar (CDII). Participants will have opportunities to suit-up in commercial diving equipment and dive underwater in The Ocean Corporation’s diver training tanks. Participants will also have opportunities to weld and burn both on the surface and underwater.

Diving and using commercial diving equipment are exciting but demanding activities. CDII participants should understand that diving and using commercial diving equipment can be strenuous and that preexisting medical conditions may affect your safety while participating.

Medical Questionnaire:

The purpose of this medical questionnaire is to identify, for both you and The Ocean Corporation, any preexisting conditions that may affect your safety while participating in CDII activities.

Participant's Name*

Cell Phone Number*

Emergency Contact Name*

Emergency Contact Phone Number*

Please check the following selections about your medical history that apply to you. Each check is the same as answering YES. Not checking a selection is the same as answering NO. Only check those or any that apply to you.

Checking a selection does not necessarily disqualify you from diving during the seminar. A checked response helps both you and The Ocean Corporation identify any preexisting medical conditions that could affect your safety while participating.

Please check all that apply to your medical condition

Claustrophobia‎Epilepsy‎Back problems‎Drug allergies‎Colostomy‎Severe hay fever‎Heart trouble‎High blood pressure‎Angina‎Ear or hearing problems‎Hepatitis‎Bronchitis‎Respiratory problems‎Tuberculosis‎Alcohol or drug abuse‎Sinus trouble‎Dizziness and fainting‎Recent surgery‎Hospitalized‎Diabetes‎Pregnant‎Back/Spinal surgery‎Ulcers‎Regular medication‎Trouble equalizing pressure‎Hernia‎Heart surgery‎Asthma‎Physical disability‎Serious injury‎Rejected from any activity for medical reasons‎

Please any medical condition not listed :

Signature: The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions or failure to disclose any existing or past health conditions. My typed name marks my agreement to all terms.*

10840 Rockley Road
Houston, TX 77099

1(800).321.0298
Fax: (281).530.9143
CDIISEMINAR.COM

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