ServSafe Manager Course Registration Form LM Please Print Clearly All ServSafe Certificates are sent electronically. *Please Note: Name: Home/Cell Phone: *Email: Site # School Name: Registration with the county where you are employed must be completed once you receive your ServSafe Certificate. NDS will email the county application you select below and your ServSafe Certificate. Please check the county where the school is located: B Bucks Chester Delaware Montgomery Philadelphia Please Check one of the following class dates: June 15-16, 2017 9:00-3:30pm October 4-6, 2017 9:30-4pm February 21-23, 2018 9:30-4pm May 9-11, 2018 9:30-4pm Please check any of the following Special Testing Needs: English as a second Language ____Visual Impairment ____Other Please explain: Send completed registration by either: Mail: Nutritional Development Services Attention: Jean Falk 222 N. 17th Street, Fourth Floor Philadelphia, PA 19103 Fax: 215-895-0831 Email: or aayella@ndsarch.org
ServSafe Manager Course Registration Form LM Please Print Clearly *Please Note: All ServSafe Certificates are sent electronically. Name: Home/Cell Phone: *Email: Site # School Name: Registration with the county where you are employed must be completed once you receive your ServSafe Certificate. NDS will email the county application you select below and your ServSafe Certificate. Please check the county where the school is located: B Bucks Chester Delaware Montgomery Philadelphia Please Check one of the following class dates: June 15-16, 2017 9:00-3:30pm October 4-6, 2017 9:30-4pm February 21-23, 2018 9:30-4pm May 9-11, 2018 9:30-4pm Please check any of the following Special Testing Needs: English as a second Language ____Visual Impairment ____Other Please explain: Send completed registration by either: Mail: Nutritional Development Services Attention: Jean Falk 222 N. 17th Street, Fourth Floor Philadelphia, PA 19103 Fax: 215-895-0831 Email: or aayella@ndsarch.org