Product Training Center		- Course Registration Request Form

-Instructions

Please complete a Course Registration Request Form. Completing a Registration Request Form does not guarantee course registration. Course registration is finilized upon receipt of a Confirmation letter. A Confirmation letter will be e-mailed unless otherwise requested. Note: If you have difficulties registering please contact the appropriate Training Location for assistance.

Fields marked with an asterisk (*) are required.

-Company Information

*	Requestor
*	Company Name
*	Street Address
*	City
	State/Province
	Postal/Zip Code
*	Country
*	Phone Number	Extension:
	Fax Number
	E-mail Address

-Student Data

* Given (First) Name

* Family (Last) Name

Student e-mail address

Student 1

Student 2

Student 3

Student 4

Student 5

Student 6

Student 7

Student 8

Student 9

Student 10

*	Interpreter Required? (Interpreter will be provided for $300 per day)	Yes No
	If yes, which Language
	Other language

-Registration Information (Based on course availability)

*	Course / Class ID		Please view Course Schedules for information on the Class ID for your selected course.
- - - -	Course Description
- -	Available Seats
- -	Training Start Date
- -	Course Location
	Wait list if class is not available?	Yes No

Note: Customers registering for a Level 2 class please note course prerequisites.

Payment Information

* Please select the payment method:

Purchase Order Number	P.O. Number: Note: Please fax a copy of your Purchase Order created for training tuition to the appropriate Training Location
Check Number	Check Number:
Available Training Dollars
Included with machine order	Machine Order Number: Note: Machine Order Number needs to be entered if course is included with the machine order.
Credit Card	Please Contact the appropriate Training Location

Universal incurs substantial costs in reserving your seat in a course. If you need to cancel your training class(es), please provide two-weeks notice to avoid incurring cancellation fees. Cancellations received within two-weeks will forfeit 50% of the tuition cost. Cancellations received within one week will forfeit 100% of the tuition cost. Also no shows on the starting day of the class will forfeit the entire tuition cost.

If Universal cancels a course, enrollees will be notified at least two weeks prior to the course start date. The class will be rescheduled or your tuition will be refunded.

Note: Standard Universal Terms and Conditions of Sale apply and are contingent upon approval of Buyers Credit by Seller.