Training Session Registration Form

Training Session Registration Form
We look forward to partnering with you and your team. To help us meet your learning needs, please thoughtfully answer each of the questions on this form. Your responses will be reviewed by your Les Encres sales partner to create your Training Day invoice, by the Les Encres Support Staff to facilitate the scheduling of your Training Day and by your Training Day Coach to help customize your educational experience.

So we may deliver best in class service to you, this form should be completed by the primary Injector who will be attending the Training along with the Owner or Manager of the hosting facility. We strongly suggest you have your Les Encres Sales Partner close by to quickly answer any questions you may have.
We will have the following necessary supplies on hand and available for use the day of our Training:
- Antibacterial Solution
- Phlebectomy Hook
- 18g Needles
- Latex Gloves
- Surgical Scissors
- Steri-Strips
- Wax Pencil(s)
- Lidocaine
I agree

Account Information
Les Encres Sales Partner*
Primary Contact Name*

First NameLast Name
Primary Contact Cell Phone Number messages about this Session can be sent.*

Area CodePhone Number
Account Name*
Account Phone Number*

Area CodePhone Number
Physical Account Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this address the same address in which the Training will be hosted?*

YesNo
If no, Please indicate why and list the address here:
Please highlight anything specific or unusual about your location/building, etc. This information will be used by your Training Day Coach to easily locate your facility:
Nearest airport and hotel recommendation.*
Please list Injector #1 name here. You may have up to 4 Injectors present during your Session. No more than three is highly recommended for your success.
Injector #1 Email Address *
Please list Injector #2 Name here
Injector #2 Email Address
Please list Injector #3 Name here
Injector #3 Email Address
Please list Injector #4 Name here
Injector #4 Email Address

Session Information
1st Preferred Training Date option. Can be no less than 3 weeks from date of payment.*

MonthDayYear
Date
2nd Preferred Training Date option. Can be no less than 3 weeks from date of payment.*

MonthDayYear
Date
3rd Preferred Training Date option. Can be no less than 3 weeks from date of payment.*

MonthDayYear
Date
The ideal start time for your 6-hour Training is:*
Once a Training date is confirmed, your account will begin to receive auto-generated emails to guide you through each step of the learning process. Messages can only be sent to one primary contact; please ensure each message is forwarded to all attendees. Training emails should be sent to the following email address:*
example@example.com

There are no right or wrong answers in this section! This is an honest opportunity to uncover where you and your team are now and where you want to be during your educational journey with Cosmetic Sutures. Your responses will be reviewed by our Training Day Coaches to help customize your educational experience.
Please list your organization's top three learning objectives during your Training Day:*
What, if anything, would prevent your organization from having a successful Training Day?*

Account Information