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2. First Name*
3. Last Name*
5. Mailing Address *
7. City*
8. State*
9. Zip*
11. County of Residence*
13. Phone Number*
15. Email Address
17. Trade / Business / Occupation
19. Please select the class date you are registering for.*
    -- Select One --Monday, April 20, 2026
21. Where did you hear about this training?
23. 
    

    Thank you for registering for the Livingston County Lead Renovator Training. By pressing submit, you are giving the Department of Health permission to contact you.

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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

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