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Submit Online Course Enrollment Data

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* Required information.

This form is used to submit data that will be used in LHS's online course enrollment system. This system will allow for you to have a personalized registration link that can be shared with anyone via email or other web-based outlets. There is a small per course fee for this service that will be charge upon generation of the link.

To ensure there are no mistakes, please make sure all data is correct and correctly entered. If you have questions regarding this form our service please contact us.
Your Name * First and Last Name
Your Phone Number * Used if we have questions
Your Email * Used if we have questions
Company Providing the Training * A client's name like ABC Fire Department or it could be just the instructor working solo. If you are an instructor working under a hospital it will be your hospital's name.
Location of Training * This might be the same as the company name but it could also be a location inside the company. For example your company might have 10 office spaces and you will meet in room 2D-123. Enter Room 2D-123.
Street Address of Training * Use the address for which someone can find the location via a map or GPS system
City of Training Location *
State of Training Location *
Zip Code of Training Location *
Training Location Phone Number * Used in case someone needs to connect with students/staff at training site.
Training Location Contact Person * Who can be contacted at this site with questions about room lay out or equipment needs?
Audio/Visual equipment on site
TV
VCR
DVD Player
WIFI
LCD Projector
Overhead Projector
Computer
Max Participants for this location? *
Special Instructors for this location?
What Type of Course? *
Other Course Title
Course Start Time * Make sure to add AM or PM or use military time
Course Start Date *
Course End Date *
Expected number of students * This can be used to "close" registration when a certain number of students has signed up.
Is this course open to the public? * Will you accept students from other organizations/community or is this a closed course for just a selective group?
Lead/Course Director's First Name *
Lead/Course Director's Last Name *
Lead/Course Director's Email Address * This is the email which rosters and sign in sheets can/will be sent to.
Second Instructor's Full Name
Third Instructor's Full Name
Addational Instructor's Full Names
Other Comments/Information

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