Workplace Integra: Training Course Registration

Training

Contact Workplace INTEGRA
at (888) WPI-0001 or by for more information.

Online Registration Form for all Southeast Courses (Greensboro, NC; Atlanta, GA; and Greenville, SC)

For the Midwest hearing conservation course registration form click here

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:

Workplace INTEGRA
PO Box 35767
Greensboro, North Carolina 27425-5767

FAX (336) 856-2945

You may also register by phone by calling (888) WPI-0001. Payment is due upon registration. Please make checks payable to Workplace INTEGRA. Payments not received 7 days prior to the course date will result in cancellation of registration.

A letter of confirmation along with directions to the facility will be sent after the registration has been received. See course descriptions for specific class times. Workplace INTEGRA reserves the right to cancel any course that does not meet minimum registration requirements.

Where did you hear about this course?

Highlight the source in the list below.

If "other" is selected, please specify

To select more than one source, hold down the "control" key.

Mac users hold down the "command" key.

Personal Information:
Fields in BOLD must be filled out.

First Name: Last Name:
Credentials: Other:

E-mail Address:
Cell Phone:

To select more than one credential, hold down the "control" key.

Mac users hold down the "command" key.

Additional Attendee(s)
2-First Name: Last Name:
Credentials: Other:

E-mail Address:
Cell Phone:

3-First Name: Last Name:
Credentials: Other:

E-mail Address:
Cell Phone:

4-First Name: Last Name:
Credentials: Other:

E-mail Address:
Cell Phone:

5-First Name: Last Name:
Credentials: Other:

E-mail Address:
Cell Phone:

Company Information:

Company Name:
Address:
Address 2:
City:	State:
ZIP+4:
Phone:
FAX:

Special Accommodation?:

Please describe below.

Course Information:

Please complete course information for each course for which you are registering.

Course 1 Title:
Course Dates:
Location:

Course 2 Title:
Course Dates:
Location:

Course 3 Title:
Course Dates:
Location:

Special Instructions:

For courses involving equipment use, such as the hearing conservation and respiratory surveillance courses, please specify your equipment make and model. If you have questions regarding this, please contact Joan Evangelista at (336) 834-8775.

Equipment type:

If you're taking the Workplace Applications Software Training, do you consider yourself a:

New User:

Intermediate User:

Advanced User:

What area(s) are you interested in?

Audio:

Pulmonary:

Health & Safety:

FMLA:

Comments or Questions:


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