For your security, please print this form to register

SMI Safety Services Application

Safety Audit	In-House Safety Training	Both Services
($1,000/Member) ($1,250/Nonmember)	($1,000/Member) ($1,250/Nonmember)	($1,800/Member)

Cost of Each Progam:
Members: $1,000 per plant, per day (plus expenses).
Nonmembers: $1,250 per plant, per day (plus expenses).
Each program requires about a day to complete and does not interfere with production.

Combine Programs and Save:
The wall-to-wall safety audit can be combined with the in-house training during the same visit for $1,800 (a savings of $200 off the regular price).

Requirements:
Participating companies are responsible for providing a suitable place for training and must have access to a television and VCR.

Company ________________________________________________________________

Address ________________________________________________________________

City __________________ State/Province ____________________ Postal Code _________

E-mail ________________________________________________________________

Telephone Fax

Person to contact _________________________________________________________

Site of audit/training (if different from above) ______________________________________

Briefly describe operations performed ___________________________________________

________________________________________________________________

Number of employees _______________ Number of shifts _______________________

Plant size (sq. ft.) _____________ Number of buildings ________ Number of floors _______

I understand the SMI Safety Audit and SMI In-House Safety Training are designed to make me aware of potential hazards and possible OSHA violations. They are not a substitute for legal advice, nor do they represent, in any way, a comprehensive study that will meet OSHA inspection standards, nor exempt the company from any OSHA inspections or violations that could be discovered during such an inspection.

Name (please print) _________________________________ Date ____________

Signature ___________________________________ Title ___________________

Payment Information Bill me at the above address

I have enclosed check # ________________ in the amount of $_______________________

Please charge this credit card - Visa MasterCard American Express

Card # __________________________________ Exp Date _________________________

Card holder's name (please print) _____________________________________________

Card holder's signature (required) _____________________________________________

Fax with credit card information to (630) 495-8595
Questions call SMI at (630) 495-8588

Please make check payable to SMI and send to:
Spring Manufacturers Institute
2001 Midwest Road, Suite 106
Oakbrook, IL 60521