Clone of Seminar Registration Form & Form F-05

Technical Associates Seminar Name

Full Name of Person filling out this Form

First and Last 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:

Estimated Number of Attendees for the Seminar:

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?

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.

Standard Course Schedule:

Set-up: Monday
Instruction: Tuesday - Thursday (8am - 5pm) followed by an in-class quiz
Examination: Friday morning

Other

What schedule would you like to follow during class (Start time, Lunch time, End time)?

ISO certification requires 38 total hours of instruction. Our standard course schedule provides credit for 27 hours - any reduction in class time increases the required hours of self-study. (ISO CAT 1 requires 30 hours of self-study; ISO CAT 2 requires 38 hours of self-study)

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?

**If the training room will NOT be available the day prior to the seminar start day, then the class should start 1 hour later on the first day.

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

Is a projector with laptop connection available in the training room? Does the training room have a TV screen or a white projector screen? (We will provide this if it is not available)

Other

Is an easel with Flipchart available in the training room? (We will provide this if it is not available)

Other

Information for the Instructor

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?

For the ICML Certification, what exam do you wish to take?

On-site Seminar Questionnaire