Provided By:
Accident Fund Insurance Company of America

In order to gain access to the Lezage Training Center service, please complete this form. All fields must be completed.

IMPORTANT NOTE: Please properly capitalize the Training Administrator's name, and enter and properly capitalize the full and proper Organization Name. Both of these names appear on employee training completion certificates, so accuracy is essential.

Training Administrator's First Name: * The "Training Administrator" is the person within your organization who is/will be responsible for the administration of your employee training program
Training Administrator's Last Name:  
Training Administrator's E-Mail Address:  
Organization Name  
Street Address  
Zip Code  
Identify Your Consultant: Use the drop-down box below to identify your WorkSafe Consultant...

Phone Number:
Current Number of Employees: * Enter a numeric value for the number of employees

After successful submission of this form, the Training Administrator will receive two confirmations:

  1. A web page confirmation (PLEASE PRINT THIS WEB PAGE), and
  2. An email confirmation (your spam filter must allow for emails to be sent by

The important information in each confirmation is identical, and the dual confirmation process is used to ensure you receive all the information you need to access and use the Lezage Training Center service.

Before submitting, please check the accuracy of the information entered.


  By clicking the "Submit" button, you agree that you've read, understand and agree to be bound by the Terms and Conditions of Use