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.
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
AutomotiveChemicalConsumer Prods.ConsultantFood/BeveragesFabrica. MetalFiberglassHVACInstrum./SoftwareMiningPetroleumPharmaceuticalPulp & PaperRepairSynthetic FiberTextilesTobaccoUtilitiesVibration ServicesTraining ServicesOther
Estimated Number of Attendees for the Seminar:*
Type of Instrumentation Used:*
Type of Software Used:*
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.
Standard Course Schedule:
- Set-up: Monday
- Instruction: Tuesday - Thursday (8am - 5pm) followed by an in-class quiz
- Examination: Friday morning
The standard course schedule is acceptableI would like to request a special modification (provide details below)Other
What schedule would you like to follow during class (Start time, Lunch time, End time)?*
I understand the ISO study hour requirements
Will lunch be provided? if not, are there dining options on-site or nearby?*
Training Room Information

(Location of the Seminar)
YesNo
**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.
YesNo
YesNoOther
YesNoOther
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?
Should be Empty:

On-site Seminar Questionnaire