Become an NSTC Instructor Name* First Last PhoneEmail* Employer Name*Employer Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Courses for Qualification* Unescorted Program ("6-Pack" + H2S/FeS) Confined Space Entry (Job Specific) Respiratory Protection (Job Specific) Energy Isolation (Job Specific) Fall Protection (Job Specific) Check the course you would like to qualify forResume*Accepted file types: pdf, jpg, doc, docx.Please upload your resume. North Slope Experience*Please list relevant North Slope / Alaska Work Experience Primary Safety Specialty* Occupational Safety Fire Protection Industrial Hygiene Construction Safety General Safety No Field Safety Experience Please check the safety specialty that best describes your overall qualification. Application Fee* Price: $ 75.00 A non-refundable $75 application fee is due with this application. The Instructor Orientation fee is $325 APICC members / $425 non-members. You will be invoiced for the Orientation fee once your application has been approved. Payment is due before Instructor Orientation, and may be made by check,purchase order, VISA or Mastercard. Instructor Orientation fee covers all all Instructor materials, NSTC curriculum, and one set of the ASH and Environmental Field Handbook. Applicants are expected to complete their Instructor qualification within six months of attending Orientation.Total $ 0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.