This form is to be completed by DLI resellers or University Ambassadors teaching paid workshops. Please submit a unique entry for each DLI workshop you're requesting.

Tell us about yourself

Your first name*
Your last name*
Your organization name*
Your email*
Your phone number*

Tell us about the customer

First name (primary contact)*
Last name*
Phone number*
(use location code beginning)

Tell us about the proposed training

Delivery format*
If providing your own online delivery platform
please identify it in the comments
Workshop title*
Training services subject to regional availability
Interested in Multiple Workshops?
Is this workshop public or private?*
Public is open for anyone to register.
Private is closed to a certain group.
Time zone*
Proposed workshop start date (mm/dd/yyyy)*
Proposed workshop start time (Hour:24hr)*
Round down to the nearest hour
Proposed workshop end date (mm/dd/yyyy)*
Proposed workshop end time (Hour:24hr)*
Round up to the nearest hour
Is the training date flexible?*
Name of training location
Street address
City of the training location
State/province of the training location
Zip/Postal Code
Expected number of trainees*
Preferred distributor
Payment Method*

Additional comments

Additional comments