MSHA Part 48(b) 8-hour Annual Refresher Pay-Later-Registration

MSHA Training Registration Form

Enter your name, email, and company billing details, including the purchase order number.
Thank you for choosing Dare 2B Safe for your MSHA training needs. You can use this form to register for training. You can register 1 student or multiple students for training. Once they are registered the person completing this form will receive an email with the course information.

We aim to see that the right people get proof of training following a course. The learner always receives a copy, but the learner's direct supervisor will also need a copy of the 5000-23 and in some company's the safety or training department also need a proof of training. We will try to accomadate sending proof of training up to two email addresses.

Training starts every day at 7:30 am and ends around 4:30 pm (all times are Mountain Time).

The training meets the requirement of MSHA Part 48(b) for Surface Mining-Metals/Non-Metals and Coal.

Annual Refresher Training is 8 hours (1 day) and can be done any day Monday-Friday.
Company Name
Register Learner's here (click "Add Row" to add multiple employees)
Course Information

We are limited on the number of learners we can have in a class, so let us know what class you are registering for and the dates:
Start Date of Training

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date of Training

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
File Upload

**Anyone registering for Annual Refresher Training MUST send a copy of their previous 5000-23 form or their New Miner 5000-23.
Cancelof
Company Contacts

These fields are not required, but if you would like Dare 2B Safe to send copies of the 5000-23(s) to your company then please drop their email address here.
Direct Supervisor Email
example@example.com
Training or Safety Representative Email
example@example.com
Company Bill Email Address
example@example.com
Company Billing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Person Completing this Form
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email for the Person Completing this Form
example@example.com
I understand that the cost of this training is $175 per student enrolled in this training and I certify that I am authorized by my company to commit to this training. I also understand that my company will be invoiced for the total amount and that payment will be due withing 30 days of the training. Signature
Should be Empty:

MSHA Training Registration Form

Course Information

Company Contacts

Person Completing this Form