Because escaped serious injury by wearing a "hard hat" at the time of an accident, I hereby make application for his/her membership in the Turtle Club.
Date of accident (application must be completed within one year of accident):
Place of accident (City, State Zip):
Full description of what happened (Copy of OSHA report is acceptable):
Hat or cap manufactured by:
Approximate age of hat or cap:
Comments:
Proposed by: Title:
Company Name: Shipping Address:
City: State: Zip:
Phone: Extension: E-mail:
Please send: ADVENT® industrial helmet with Turtle Club insignia Conventional hard hat with Turtle Club insignia
I hereby certify the statements made above are true in every detail Todays Date: