Preview of Form (Download Below)


Food Safety Plus

Seminar Registration Information

* ServSafe Food Manager Protection and Certification Exam Session Registration Form
* ServSafe Food Handler and Certification Registration Form


Session Date:                                   RSVP:

Name/Title: _____________________________________________________

Company/Organization Affiliation: __________________________________

Mailing Address: ________________________________________________

City, State, Zip Code:_____________________________________________

Email Address: 
_____________________________________________ 

Telephone #: _____________________________________

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Session Type: please check one
___ ServSafe Food Protection Manager session with ServSafe certification examination, 5-year compliance
___ ServSafe Food Protection Manager session without ServSafe certification exam
  (NYS Department of Agriculture and Markets certificate of attendance, 2-year compliance

​___ CPEU’s Awarded @ 6.5 CPE Level 2, 3, Learning Code Need 8040
  Commission on Dietetic Registration, Academy of Nutrition & Dietetics continuing education credits approved
___ CE's Awarded - Association of Nutrition & Food Service Professionals, Certified Dietary Managers approved
___ ServSafe Food Handler with certification, 3 year compliance

​Location of Sessions:
On-site per client request request 

OR

Amherst Senior Center, 370 John James Audubon Parkway, Amherst, New York 14228

_____________________________________________

Fees: Variable

1.    ServSafe Food Protection Manager Seminar and Certification Exam
2.    ServSafe Certification Exam – results available within 10-14 days
3.    ServSafe Certificates mailed to attendee upon receipt from NRAEF
4.    ServSafe Certification upon successful completion is compliant for 5 years
5.    Certificate of Attendance mailed to attendee - 2-year certificate New York State Department of Agriculture and Markets
6.    Certificate CPEU's and CE's- Provided to attendee at session - as per client request
​7.    Lunch provided 

Purchase Test Materials at least 2 weeks prior to ServSafe Food Protection Manager Training Session:
Request ServSafe Manager (7th edition) with certification answer form @ 1-800-765-2122 Ext. 6703
OR: Purchase materials on line @ http://www.servsafe.com
OR: Melissa Rouzer @ Melissa@fsts.net OR 1-855-644-3787 ext. 103 OR 1-717-325-4748

Electronic Invoices are available - contact till.lori@gmail.com for this option
Payment for session as determined:  Check payable to Dr. Lori L. Till OR
Credit payment with small processing fee
- Email OR Please fill out, print and mail registration 2 weeks prior to session to:
- Dr. Lori L. Till, Associate Professor
- 9653 Garden Walk, Clarence Center, New York 14032

​Notification of receipt of registration information/payment will be confirmed via email. If you have any questions,
​contact @ 716-725-8624 or till.lori@gmail.com.