CATERPILLAR EQUIPMENT TRAINING SOLUTIONS

Operator Training Program Registration Form

(THIS FORM MUST BE RETURNED

BEFORE REGISTRATION WILL BE CONFIRMED)
Please fax your enrollment to: 309-675-5824

Attendee Name______________________________________________________________________________________
(As it should appear on the nametag)

Company Name _____________________________________________________________________________________

Company Address ___________________________________________________________________________________

street city state zip code
Telephone Number _______________________________ Facsimile Number ____________________________________

Start Date of Training _____________________________ End Date of Training _________________________________

Place of Training _________________________________Attended training in past (details)? _______________________

Customer Billing Name: ___________________________Attn: _________________________________________

Address: _______________________________________________________________________________________

Final Cost Agreed (if known): __________________________________________________________________________

HOTEL REQUIREMENTS AND INFORMATION (if applicable)

In case of an emergency or change in class schedule, please provide us with the name of the hotel you are staying at during
our class.

Name of Hotel:______________________________________________________________________________________

FLIGHT INFORMATION (if applicable)

ARRIVAL DATE: ____________ Airline ____________ Flight # _______ Arrival Time ________

DEPARTURE DATE: _________ Airline ____________ Flight # _______ Departure Time ________

For Caterpillar use only:

Caterpillar Dealer___________________________________________________ Customer Code ____________________

Caterpillar Dealer Salesman ______________________________ Telephone Number _________________________

CDI______________________________

Please fax your enrollment to: 309-675-5824

 CATERPILLAR EQUIPMENT TRAINING SOLUTIONS

Operator Background Sheet

(MUST BE RETURNED WITH REGISTRATION FORM)
Please fax your enrollment to: 309-675-5824

NAME__________________________________________________________________________________

ADDRESS ______________________________________________________________________________

HOME PHONE _____________________________ BUSINESS PHONE ___________________________

EMPLOYER _____________________________________________________________________________

POSITION ______________________________________________________________________________

TYPE OF WORK COMPANY PERFORMS_____________________________________________________

_________________________________________________________________________________________

WORK ATTENDEE CURRENTLY DOING (dozing, loading trucks from stockpile, trenching, etc.) __________

_________________________________________________________________________________________

EQUIPMENT EXPERIENCE (MAKE & MODEL)

On what equipment do you have previous operating

experience? (example: D8K, 12G, 325, etc.)
How many years of operating experience do you
have on the above equipment?
Others:

APPLICATION EXPERIENCE (TYPE)

In what applications do you have operating

experience (dozing, grading, loading, trenching) ?
How many years of operating experience do you
have in the above applications?

What are your expectations from attending this training?

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Please fax your enrollment to: 309-675-5824