PerformanceExpert Services
SourceMedical Classroom Training
Classes with less than five registrants are subject to cancellation. In the event that an insufficient number of registrants results in class cancellation, you will be informed of the cancellation no later than fifteen business days prior to the date for which the class had been scheduled.
SourceMedical Classroom Training Request Form
Requestor Name
Requestor Company
Class Name
Requestor Email
Requestor Phone
Attendee Name(s)
Company Code
Leading Source for Outpatient Solutions
Attendee Email(s)
By checking here and submitting this form, I authorize attendance of members of my organization in the SourceMedical Classroom Training indicated on this form. I am authorized to enroll members of my organization for the SourceMedical class and I understand that the payment method I select will be applied for each class attended. Any cancellation occuring within ten business days of the scheduled class start date is subject to a cancellation fee equal to 50% of class tuition.
Payment Method:
Comments:
Address
City
State
Zip
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Attendee Job Role(s)
and Experience Level(s)
