MSI TRAINER REGISTRATION AND REQUEST FORM

MSI Certified Trainer Registration Form

To apply for certified trainer designation, please complete the following information:
DateTime
First Choice Date

MonthDayYear
Date
Select MT1 Trainer Certification Class 9am - 5pm Virtual:*

January 24-26, 2024March 20-22, 2024June 19-21, 2024August 7-9, 2024November 6-8, 2024
Second Choice Date

MonthDayYear
Date
Registrant Information
First Name: *
Last Name: *
Organization:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail:*
Phone including extension if applicable:*
Education & Interest
Organization Type (check all that apply):*

Secondary EducatorPost-Secondary EducatorCorporate TrainerWorkforce Development AgencyManufacturerState AgencyOther
Manufacturing Industry Experience (check all that apply):*

0-1 year1-2 years3-5 years5+ yearsOther
Send an invoice with payment instructionsSend a paid invoice as my credit card receipt
Billing contact information
First Name: *
Last Name: *
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing & Receipt Email*
example@example.com
Payment Options

Send an invoice with payment instructionsPay by credit card to complete my registration
Secured Payment:

Please complete the credit card information below to complete your registration.

How did you hear about us:

EmployerWebsiteFlyerEventReferralMSI email communicationOther
To submit, review the cancellation policy and agree then select the submit below.

MT1 Trainer Certification Cancellation Course Cancellation Policy.

If you must cancel, then cancellation must be made at least 10 days prior to the MT1 Trainer Certification Course session start date to receive a refund less 15%. Registration may be transferred to another trainer candidate with permission from MSI.
Please allow at least 5 business days for processing.

Manufacturing Skills Institute, 2112 W Laburnum Avenue, Suite 205, Richmond, VA 23227
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MSI Certified Trainer Registration Form