Clone of Seminar Registration Form & Form F-05

On-site Seminar Questionnaire

Please fill in the form below to help us better prepare for your seminar.
Full Name of Person filling out this Form*

First NameMiddle NameLast NameSuffix
Technical Associates Seminar Name*
Job Title*
Work Phone*
Area Code - Phone Number & ext.
Cell Phone Number
Area Code - Phone Number
Business E-mail*
Company*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Type of Industry and Product Manufactured/Services Rendered by your Company:*

AutomotiveChemicalConsumer Prods.ConsultantFood/BeveragesFabrica. MetalFiberglassHVACInstrum./SoftwareMiningPetroleumPharmaceuticalPulp & PaperRepairSynthetic FiberTextilesTobaccoUtilitiesVibration ServicesTraining ServicesOther
Type of Instrumentation Used:*
Type of Software Used:*
Will the instrument and software be available for use by the instructor and students during the seminar?*

YesNo
Seminar Information

(Location of the Seminar)
What is the physical address where the seminar will be held?*

Seminar Location Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is this a Business or Hotel Address?*
Where would you like your Seminar materials to be shipped?*

Shipping Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
To whose attention should seminar materials be shipped?*
Full Name
Please ensure mailing address is correct to avoid additional shipping costs for returned mail.
What schedule would you like to follow during class (Start time, Lunch time, End time)?*
What days of the week do you want the seminar to be held?*

Monday to Wednesday class; Thursday test in the morningTuesday to Thursday class; Friday test in the morning (preferred)Other
Will lunch be provided? if not, are there dining options on-site or nearby?*
Training Room Information

(Location of the Seminar)
Will the training room be available the day prior to the seminar for the instructor to set up?*

YesNo
Is a projector with laptop connection and screen available in the training room?*

YesNo
Is there internet access in the training room that the instructor can connect to?*

YesNo
Instructor Information
Name of contact person for the instructor to contact upon arrival at your facility*
Contact person's phone number (office/cell)*
Contact person's Email*
example@example.com
What airport do you recommend the instructor fly into?*
Are there any specific gates, parking areas, or entrance instructions that the instructor needs to be aware of?*
Do you have any specific hotel recommendations for the instructor? Is there a corporate rate available?*
Are there any safety training requirements that need to be met prior to the seminar?*
What safety apparel / PPE does the instructor need to bring?*
ATTENDEES: Names, Titles, and Email Addresses of all Persons registering for the seminar. (NOTE: Provide names as they should appear on the Certificate).*
Do you want your staff to take the Certification Exam?*
For the Asset Lubrication Technician Seminar, what exam do you wish to take?*
Should be Empty:

On-site Seminar Questionnaire