Training Reservation Request

Course Information

Course Name *

Course Dates *

Name of Your Institution *

Street Address *

City *

State

Zip Code *

First Attendee

Please list below the name(s) of those requesting to attend.

First Name *

Last Name *

Title

Department

Phone Number *

Alt Phone Number

Email Address *

Include Second Attendee

Second Attendee

First Name *

Last Name *

Title

Department

Phone Number *

Alt Phone Number

Email Address *

Additional Information

Comments

Dietary Requirements

Sales Order Number

Institution Purchase Order Number

Vyaire reserves the right to cancel any course three (3) weeks in advance due to insufficient registration. Cancellations by students must be received three (3) weeks prior to scheduled class date in order to obtain a credit for the course. Penalties may be applied if cancellation is received with less than a three (3) week notice.

Please wait to receive confirmation of your course registration before making any travel arrangements.