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On-Site Registration Form 

 

  Required Items. Please read the cancellation policies.

Use this form to enroll in On-Site Training courses.  Use a separate form for each on-site request.   You will be notified by email that your dates and on-site registration has been accepted. 

 

Agency Name

 

Contact Name

 

Billing Address

 

City

 

State              ZIP

 

Phone:   

 

Fax:

 

Email:

 

On-Site Course:    

 

 Specify:

 

On-Site Date(s)  

 

Alternate Date:

 

Number of Student to be trained:

 

Max Number of students is unlimited.  HSU will supply manuals for up to 10 students only!

 

Who is being trained?:

 

Fee: The fees included below are priced both with trainer travel expenses.  The with cost includes 10 training manuals, all handouts, and agendas.  

 

The without cost does not include travel expenses for on-site trainer.  Programs who choose to book travel expenses for our trainers,  must have expenses completed within 30 days of trainers travel.  Travel expenses will include 3 meals per day, hotel, travel insurance for trainer, airfare and transportation cost to and from agency. Trainers are not allowed to stay weekend without prior HS University approval.  Weekend stays will include added expenses of hotel and food as well as added travel insurance.  Agencies that book weekend stay without HSU approval will incur rebooking and cancellation cost of flight to bring onsite trainer back to home destination.  You may contact our office for more details. 

These prices are for 10 people.  For over 10 people, please contact Thomas at (901) 748-0293 x222 for pricing & scheduling.

 

Prices effective as of January 1, 2013.

                                                                                           Prices include travel expenses

     1-Day ($4995 plus travel)    

  5-Day ($6995 plus travel)

  2-Day ($5495 plus travel

  Credentialing 3-Day for 10 people ($14950 plus travel

  3-Day ($5995 plus travel)

  Credentialing 3-Day for 11 or more (Call for pricing

  4-Day ($6495 plus travel

 

 

Comment or Special Request:

 

Extra Fees: 

     LCD Projector ($125) 

An LCD projector must be provided for all courses! If your agency is unable to provide this for trainer,  please check here and add $125 to total fees below!

     Extra Manuals ($35 each x number of students ; HSU will supply 10 manuals for FREE)

Total for Extra Manuals:

     CEUs ($25 per person) CEUs will be issued 4 to 6 weeks after  course is completed.  Please list attendees for which a CEU is 

         needed below.

Total for CEUs:

 

    Certificates ($5 per person)  Certificate of training will be sent for each  

           participant.  Please list each participant to receive a certificate below.

 

Total for Certificates:

 

Attendees: (Please list Names, Agency, Address if different from above.  Certificates/CEUs will be mailed to contact listed above.)

 

       

Payments:  (See payment instructions below.)

 

Total: $

 

 

Make your check payable to HS University or charge all fees to:

MasterCard        Visa          Discover     American Express

 

Card No.  

 

Expiration Date

 

Please bill the company: letter of authorization or purchase order will follow via fax at 901-748-0297.

 

I have read cancellation policies below.

 

Signature

 

Date

 

An site registration form will be mailed once your registration form is received.

 

 

Payment: Fees are due 15 days after online registration has been confirmed or 14 business days prior to onsite, whichever is first. 

 

Cancellation:  Agency may cancel  on-site only if cancellation is received at least 25 business days prior to on-site.  A $25 cancellation fee will be charged. If cancellation is received 24-15 business days prior to onsite, 50% of onsite fee will be refunded.  If cancellation is received 14 or less; no refund will given.  Agency may reschedule an on-site is done 10 business days prior to onsite.   

 

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