DATIA Course Registration
 
 
Company Name
Primary Contact Name
Primary Contact's Email
Address
City
State
Zip
Phone
Fax
Website
DATIA Member ? Yes No      Not a member? Join Now!
Notes
Attendee #1
Name
Email
Complete below only if address is different than company
address:
city
state
zip
telephone
fax
Choice Dates (You must select a date after choosing a course)
Notes:
Course and Workshop Registrations
Number
Fee*
Total
Ins & Outs of Drug Testing
$389
Supervisor Training
$389
Certified Professional Collector Trainer Course
$389
MRO Assistant Course
$389
Consortia/Third Party Administrator Best Practices
$389
DER Train-the-Trainer Course
$389
Advanced Designated Employer Representative Course
$349
Substance Abuse Professional Course
$329
Auditing Success Course
$329
Advanced Collection Issues & Best Practices
$349
Collector Refresher and Mock Collections
$349
Alternative Specimen
$389
Total Number of Unique Attendees
Multiple Course Discount**
Subtotal of Registrations
**DATIA's Course Discounts! When an individual registers for two or more courses he/she gets one of the following discounts! All registrations must be on this one form, with payment.
  • 2 courses $50 Discount
  • 3 courses $100 Discount
  • 4 courses $150 Discount
  • 5 courses $200 Discount
  • 6 courses $250 Discount
  • 7+ courses $300 Discount

Promo Code
(if provided)

Refund/Credit Policy:

Cancellations made at least 30 days before the program will receive a full refund; cancellations made at least 14 days before the program will receive a full refund less a $50 administrative fee; and cancellations made less than 14 days before the program are nonrefundable. All refund requests must be submitted in writing.

DATIA reserves the right to cancel any and all courses 30 days prior to the date of the course(s) if five or less people are registered for any DATIA Seminar. DATIA will refund the course fee or offer a credit to attend the course at any date or location offered by DATIA within a year from the cancelled course date. DATIA will not incur any hotel or travel costs of attendees from a cancelled course. For any further questions regarding this policy please contact DATIA at 800-355-1257.
Totals
TOTAL
Payment
Payment:
VISA MC AMEX
Credit Card Number Expires:
Cardholder Name Cardholder Phone
You may also print and fax this form to 202-315-3579 or mail it to 1325 G Street, NW, Suite 500-#5001 Washington DC 20005
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