2. ServSafe Course and Proctored Exam Registration
4. Today's Date:*
   Today's Date:
6. First Name*
7. Last Name*
9. Phone Number*
10. Email*
12. Prefered contact method:*
    -- Select One --PhoneEmail
13. I would like to register for:*
    -- Select One --Class instruction and Proctored ExamProctored Exam

    Class instruction is not required to register for a Proctored exam.

17. Please select the date(s) below for your class and/or proctored exam.

    *Class instruction is not required to take the proctored exam.*

19. Class Instruction Date:
    -- Select One --3/3/20225/5/20228/2/202211/1/2022
20. Proctored Exam Date:*
    -- Select One --3/3/2022 (I&P)3/17/2022 (P)5/5/2022 (I&P)5/19/2022 (P)8/2/2022 (I&P)8/16/2022 (P)11/1/2022 (I&P)11/15/2022 (P)

    P = Proctoring only offered

    I&P = Instruction and Proctoring offered

24. A $75 fee will be required SEVEN DAYS proir to the date of Instruction and/or Proctoring.

    Payments can be made by phone at (252) 636-4936 or by cash and check at the Craven County Health Department.

    **To Confirm that you have registered and signed up for the class or proctored exam, call (252) 636-4936.**

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field