Hearing Conservation Initial Training Course Registration for Workplace Integra

Use this on-line registration form to register for scheduled courses offered by Workplace INTEGRA. The form may be submitted online or you may use our printable registration form and fax or mail it to our office at:

You may also register by phone by calling (888) WPI-0001.

Payment

Payment is due upon registration. You may pay by credit card by using our online shopping cart (follow directions once you've completed this registration form), or by calling us with your credit card number. If paying by check, please make checks payable to Workplace INTEGRA. Payments not received 7 days prior to the course date will result in cancellation of registration.

A confirmation letter will be sent after your course registration form is received and processed. Directions to the facility and any special instructions will be included.

If you do not receive a confirmation letter by a week before the class starts, please call 336 834-8775.

See course descriptions for specific class times. Workplace INTEGRA reserves the right to cancel any course that does not meet minimum registration requirements.

Important: If you cannot attend the class for which you have registered, we will offer you an alternate date(s). Requests for a refund for a class paid for with a credit card will result in a service fee of at least $100.

Attendee Information:

* Required fields

* First Name:	A value is required.
* Last Name:	A value is required.
* Mobile Phone:	A value is required.
* E-mail:	A value is required.Invalid format.
Address: (if different from billing address)

Second Attendee:
First Name:
Last Name:
Mobile Phone:
E-mail:
Comments:
	Note: If signing up two people for two different courses, please indicate course for each attendee in this comments field (e.g., August 9-11, 2011)

Hearing Conservation Initial Course Registration Form

Attendee Information:

Course Selection:

Hearing Conservation Initial Training