US Army Center for Health Promotion and Preventive Medicine
Training & Conferences

Registration/Application Request

Transport of Medical Waste Course (CHPPM-3715)
Privacy Act Statement
 Title 5 US Code, Section 301; Executive Order 9397 authorizes the use of your Social Security Number as an identification number. The purpose of this information is for recordkeeping only. Having read the preceding Privacy Act Statement submission of this electronic form indicates applicants consent.
   23 - 25 August                       13 - 15 September
Fields marked with a red * are required. Use the TAB Key to navigate from field to field.
*Name w/ Middle Initial:   
*Job Series/AOC:        
*GradeRank:          
*SSN&#47Country Identifier:   
*Job Title:          
Component: Army, Navy, Civilian DAC, (Non-Gvt)/ Contractor, etc:   
Gender:   Male   Female
Office Mailing Address:
*E-Mail Address:     
                       AKO / NKO E-Mail Address:   
                       Other E-Mail Address:   
Provide a brief description of your current duties and responsibilities:
How long have you been in your current position&#47assignment?   
Have you attended a training course on Regulated Medical Waste Packaging previously?   Yes   No
If yes, give the dates:   
How long was the training:   
It is necessary for the applicant to have verbal supervisory approval before submission of this form.
Supervisors Name       
Supervisors Title      
Supervisors E-Mail     
Supervisors Phone