Sign-Up Form

THE ONLINE TRAINING PROGRAM

Thanks for enrolling your institution. Please enter the information below and we will set your account up and then send an email with instructions on accessing your modules and your institution's records page.

 

Enter the institution name here:

CONTACT INFORMATION

Information for the person that will receive training records

Enter contact's name here:

Enter contact's address here:

Street

CityState Zip

Enter contact's email address here:

Enter contact's telephone number here:

Enter contact's fax number here:

Preference of monthly report of participants: (The contact also receives the auto emails when a participant completes a module)

a hard copy a file attached to an email both methods

 

INVOICING INFORMATION

Information for invoicing your institution

Send Invoice to this address

Payment Method (select one method)

Purchase order Credit Card Other Method

Please call us at 800-262-5282 or fax us at 817-492-9300 with your PO number or credit card number.

Which account level do you want

Departmental level ($50 /mo) Institutional level ($75 /mo)

What date would you like to start the program

 

INSTITUTIONAL LEVEL OPTIONS

Please check any options you want ( no charges for options)

We want to use our list of departmental names for participants to choose when they sign in - the list will be attached to an email addressed to LATA - limit to 99 names

We want to change some text in the modules and the edits are attached to an email addressed to LATA

We want the auto-email notice of module completions to be sent to the participant in addition to the contact person listed above

 

Now click on "Submit Record" button below to forward your information to LATA.