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ServSafe® Registration Form
Please PRINT name as you wish it to appear on your certificate. Copy this form as needed for additional participants.
Name: _________________________________________________ Company Name: __________________________________________
Preferred Mailing Address: ____________________________________________________________________________________________________
_____________________________________________________________ Phone: (W)_____________________ (H) _____________________
City State Zip
**DEADLINE TO REGISTER: 2 weeks before scheduled class**
Checks should be included with registration form. A late fee of $25.00 will be charged for checks not received by deadline.

Make sure you mail registrations and make checks payable according to the class location you are registering for. (See adjacent list)

Please indicate if you would prefer to have the test and course book
in one of the following forms:
___Korean ___Chinese ___Japanese ___French Canadian
___Spanish ___Large Print English (test booklet only)
A standard English test and book will be provided unless otherwise noted.

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Registration and checks should be mailed to the following depending on the location you will attend:
Baxley, Ga. March 1-2, 2012
Appling Co. Cooperative Extension
Attention: Janet Hollingsworth
P.O. Box 478
Baxley, Ga. 31515
(912)367-8130
Checks payable to: Appling Co. FACS
Brunswick May 22-23, 2012
Glynn Co. Cooperative Extension
Attention: Deborah Jones
325 Old Jesup Road, Ste.110
Brunswick, Ga. 31520
(912)554-7579
Checks Payable to: Glynn Co. 4-H
Blackshear, Ga. June 13-14, 2012
Ware Co. Cooperative Extension
Attention: Heidi Flowers
605A Church Street
Waycross, Ga. 31501
(912)287-2456
Checks Payable to: Ware Co. Ag Account

Select your class from one of the following locations:
Baxley: March 1-2, 2012
Brunswick: May 22-23, 2012
Blackshear: June 13-14, 2012
Registration Deadline:
2 weeks before class
Baxley: Feb. 15, 2012
Brunswick: May 7, 2012
Blackshear: May 29, 2012

Course Instructors:
Janet Hollingsworth, MEd FACS Agent Appling & Wayne Co.
Heidi Flowers, BS FACS Agent Ware & Pierce Co.
Deborah Jones, MSH,CDE FACS Agent Glynn Co.
Lisa Jordan, MEd EFNEP Agent Chatham Co.

Two—Day
Training Schedule

Are You...
A Food Service Worker?
A Manager in Training?
A School Nutrition Employee?
ServSafe® leads the way in providing the restaurant and food service industry with an up-to-date, comprehensive food safety training and certification program.
The ServSafe® food safety training and certification program is recognized by more jurisdictions than any other manager food safety program, because ServSafe® has the highest standard in training and certification. It is a mindset and the means to ensure your operation follows guidelines that will protect your customers and your business.

The University of Georgia and Ft. Valley State College, the USDA and Counties of the State cooperating. The Cooperative Extension offers educational programs, assistance, and materials to all people without regard to race, ethnicity, national origin, color, sex, sexual orientation, religion, age, disability, or veteran status. AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION
ORGANIZATION.

ServSafe® Course
Includes:
The ServSafe® Serving Safe Food Essentials Book
16 hours of instruction
A certificate from NRAEF issued upon successful completion of the examination which is accepted by over 95% of all state and local jurisdictions that require training and/or testing.
Certification Test:
Participants have shown 87% passage rate on previous ServSafe® exams.
Course Fee:
$140 per person; includes course book, exam booklet, 16 hours of instruction and test
administration.
$60.00 Re-test fee

Day One
Registration: 8:00 a.m.—8:30 a.m.
Class: 8:30 a.m.—5:00 p.m.
Providing Safe Food
The Microworld
Contamination, Allergens, Illness
The Safe Food Handler
The Flow of Food
Day Two
Class: 8:00 a.m.—5:00 p.m.
Food Safety Management Systems
Sanitary Facilities and Equipment
Cleaning and Sanitizing
Integrated Pest Management
Systems
Food Safety Systems, Regulations and Standards
Employee Food Safety Training
Review of Exam
Certification Exam

Important Information:
Deadline to register: 2 weeks before the class
Cost: $140.00; Retest Fee: $60.00
No Refunds. Substitutions are allowed.
After registration deadline, confirmation and additional details will be mailed to the participant.
Class size limited to 35 participants. (Must have at least 10 to hold a class.)
Participant will receive certification from the National Restaurant Association, if participant passes exam.

After registration deadline,
confirmation and additional details will be mailed to the participant.

After registration deadline,
confirmation and additional details will be mailed to the participant.