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Food Manager Certification Registration Form
(Please use one form for each registrant.)

Please complete the form and mail it with a check or money order to:
American Food Safety, 2734 North 5th St, Philadelphia, PA 19133
or you may register by phone or fax by calling (800) 723-3873 or faxing (215) 634-6184.

Class sizes are limited, so please register early.

Student Name:

Student Address:

Day-Time Phone:

Business Name/City:

Fax Number:

Course Language

Location (City/State):

Course Date:

Send Registration Details