Request form for in-company training

This form is essential to create the best possible quotation based on your requirements and to prepare technically for the in-company training.

1.  Contact details
Company:
Contact person:
E-mail address: / o no mailing
Phone number:
Fax number:
Address where the training takes place:
Postal code / City / Country:
VAT number
(leave it open if you do not have this):
2.  Training details
Required training: / q  Certified PROFIBUS Engineer (4d, min. 6 & max. 15 participants)
q  Certified PROFIBUS DP/PA Engineer (5d, min. 6 & max. 15 participants)
q  Certified PROFINET Engineer (3d, min. 6 & max. 15 participants)
q  Troubleshooting & Maintenance (2d, min. 6 & max. 15 participants)
q  Other (min 6. participants): ______
Number of sessions:
Participants per session:
Possible dates:
Language: / q  English
q  German
q  Dutch
Technical level (on behalf of PROFIBUS or PROFINET): / q  Beginners
q  Experienced
q  Cannot be determined
Desired time block: / q  8.00 AM to 4.00 PM
q  8.30 AM to 4.30 PM
q  9.00 AM to 5.00 PM
q  10.00 AM to 5.00 PM
q  10.00 AM to 4.00 PM
q  Other:
3.  Details training room
Projector + screen. / q  Yes
q  No
Flipchart or whiteboard. / q  Yes
q  No
Enough 110/230 V connections (spread over the training room). / q  Yes (110 V)
q  Yes (230 V)
q  No
Internet connection for at least 1 workstation/laptop. / q  Yes
q  No
Tables and chairs can be moved
(for the practical sessions). / q  Yes
q  No
4.  Location details
Car can be parked directly in front of the entrance (unloading the training materials). / q  Yes
q  No
Stairs have to be taken to go from parking place to the training room. / q  Yes
q  No
Training materials can stay in the room during the training period. / q  Yes
q  No
Hotel is located nearby. / q  Yes, with a cooperate discount.
q  Yes, but not with a cooperate discount.
q  No
Instructors have to bring identification. / q  Yes
q  No
Instructors have to bring protective measures. / q  None
q  Helmet
q  Special shoes
q  Hearing protection
q  Glasses
5.  Others
Participants can bring a laptop or PC (minimum 1 per 2 participants). / q  Yes
q  No
Lunch, drinks and others are arranged. / q  Yes
q  No
6.  Remarks

Please fax or email this list to:

PROCENTEC

Fax: +31-(0)174 – 671 801

Tel.: +31-(0)174 – 671 800

Email:

Version 4.1.2 - 10 November 2013 3 / 3

Training-Request-EN.docx © PROCENTEC 2013