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Florida Mine Safety
Health & Training Program
About
Who We Are
Advisory Board
Partners in Safety
Courses
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2024 Competition
2025 Competition
Events
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Careers
MSIA
Contact
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About
Who We Are
Advisory Board
Partners in Safety
Courses
Competition
2024 Competition
2025 Competition
Events
Workshops
Media
Careers
MSIA
Contact
Team Competition Registration
"
*
" indicates required fields
Step
1
of
6
16%
Team Name:
*
Company Name:
*
Company Address:
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Which Rules Do You Wish Your Team To Be Judged By:
*
National Rules
Regional Rules
Does Your Team Qualify for Novice Team?
Novice Teams (if requested) are defined as a team that is within the firsts 2 years of competing.
Yes
No
Team Contact Name:
*
First
Last
Team Contact Email :
*
Team Contact Phone:
*
Number of Members on Team
*
(Minimum of 3 Team Members and Maximum is 8 Team Members.)
Team Members
A Team is defined as three to five Team Members and one Team Trainer. Additional Team Trainers will need to register as Non-Competitors.
Team Captain Name:
*
First
Last
(The Team Captain is the designated Team Member 1)
Team Captain Shirt Size:
S
M
L
XL
XXL
Team Captain Glove Size:
S
M
L
XL
2XL
3XL
Do you have a Team Trainer?
*
No, we do not have a Team Trainer
Yes, we have a dedicated Team Trainer
Yes, we have a Team Trainer who serves as Team Captain too
Team Trainer Name:
First
Last
Team Trainer Shirt Size:
S
M
L
XL
XXL
Team Trainer Glove Size:
S
M
L
XL
2XL
3XL
Team Member 2 Name:
*
First
Last
Team Member 2 Shirt Size:
*
S
M
L
XL
XXL
Team Member 2 Glove Size:
*
S
M
L
XL
2XL
3XL
Team Member 3 Name:
*
First
Last
Team Member 3 Shirt Size:
*
S
M
L
XL
XXL
Team Member 3 Glove Size:
*
S
M
L
XL
2XL
3XL
Do you have more than 3 team members? If so select the correct number below:
*
No
Yes, we have 1 more team member
Yes, we have 2 more team members
Yes, we have 3 more team members
Yes, we have 4 more team members
Yes, we have 5 more team members
Team Member 4 Name:
First
Last
Team Member 4 Shirt Size:
S
M
L
XL
XXL
Team Member 4 Glove Size:
S
M
L
XL
2XL
3XL
Team Member 5 Name:
First
Last
Team Member 5 Shirt Size:
S
M
L
XL
XXL
Team Member 5 Glove Size:
S
M
L
XL
2XL
3XL
Team Member 6 Name:
First
Last
Team Member 6 Shirt Size:
S
M
L
XL
XXL
Team Member 6 Glove Size:
S
M
L
XL
2XL
3XL
Team Member 7 Name:
First
Last
Team Member 7 Shirt Size:
S
M
L
XL
XXL
Team Member 7 Glove Size:
S
M
L
XL
2XL
3XL
Team Member 8 Name:
First
Last
Team Member 8 Shirt Size:
S
M
L
XL
XXL
Team Member 8 Glove Size:
S
M
L
XL
2XL
3XL
Monday Training Classes
Monday, March 4, 2024: Basic Confined Space Entry ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees being Registered
Names of Attendees
Monday, March 4, 2024: Basic Basic Firefighting ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees being Registered
Names of Attendees
Monday, March 4, 2024: Basic Vehicle Extrication ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees being Registered
Names of Attendees
Monday, March 4, 2024: Awareness Level Training for Hazmat ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees being Registered
Names of Attendees
Monday, March 4, 2024: 1 st Aid Refresher, CPR and AED Practice ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees being Registered
Names of Attendees
Tuesday Training Classes
Tuesday, March 5, 2024: Basic Confined Space Entry ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees being Registered
Names of Attendees
Tuesday, March 5, 2024: Basic Basic Firefighting ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees being Registered
Names of Attendees
Tuesday, March 5, 2024: Basic Vehicle Extrication ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees I’ll be Registering:
Names of Attendees
Tuesday, March 5, 2024: Awareness Level Training for Hazmat ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees I’ll be Registering:
Names of Attendees
Tuesday, March 5, 2024: 1 st Aid Refresher, CPR and AED Practice ($50.00 per person)
Yes, I’d like to register for this session
Class is from 6:00 am – 3:00 pm
# of Attendees I’ll be Registering:
Names of Attendees
Florida Public Safety Institute Housing
Are you interested in housing?
*
Yes, I’m interested in housing
No, I am not interested in housing
Date In:
*
MM slash DD slash YYYY
Date Out:
*
MM slash DD slash YYYY
# of Single Rooms to Reserve ($36 per room per night):
*
0
1
2
3
4
5
6
7
8
# of Double Rooms to Reserve ($29 per bed per night):
*
0
1
2
3
4
5
6
7
8
Are you bringing additional guests to the Awards Banquet (includes a reception and dinner) for a fee of $30 per guest?
*
Yes, I'm bringing additional guests
No, I'm not bringing additional guests
# of Additional Awards Banquet Guests
*
Name
This field is for validation purposes and should be left unchanged.
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