Training Location Questionnaire

Please fill out and submit the form below.

Full Name*



• What is the Physical Address of Training Location:
  Facility Name*
     
• Address*
• 
  City*
•  State* Zip*
• 
  

  Course room

  Name/Number:   Room/Location:  



• ** Please include specific driving and parking instructions**

• Driving and Parking Instructions:*
  
• Please include helpful description of building and entrance.


• Any Additional Instructions ( If your facility is part of a larger campus, please be very clear as to the building name and location or provide a campus map).
• Estimated number of attendees:*
  Type of facility:  
• Brief description of main clientele treated:
• 
  

  What shipping address should we use for sending training materials:*

• Same as facility location address.
  Different Address:
• Send items to the Attn.:*


Equipment Verification

• Do you have access to AV equipment? Please select all that apply:
• In person training:
• LCD projector ** TV **
• Online Training:
  Internet connection  Computer Speakers Microphone Webcam
  
  
• Your LiteGait equipment is:
    Uncrated   Assembled   In working condition
  
• Is LiteGait equipment located in the same room as the presentation? Yes  No
• Do you have a Treadmill? Yes  No
• If yes, do you use this Treadmill with the LiteGait? Yes  No

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* Fields marked with an asterisk are required.

** Not all instructors use LCD projector for their presentation, if you need to reserve the equipment please verify with us prior to doing so. It would be better if you have access to a TV with a VGA port on the back.(Any monitor cable can be used for the connection).