Please verify your site information below and make any necessary changes before clicking SUBMIT.                 

 * Denotes Required Field

Course:
 

      

Your Name:

   * 

Your Title:

      

Phone:

   * 

Fax:

      

Email:

   * 

Satellite Tech Name:

       (optional)  Email:    (optional)

Site Name:

   * 

Address:

 

   * 
     

City:

   * 

State:

      

Zip Code:

         If outside the US please leave blank.

County:

         If outside the US please leave blank.

Country:

      
   

Select How Course Viewed:

      
   
       Estimated Audience For Live Satellite Broadcast Viewing: 
                          *         (0-?)
       Estimated Audience For Future Video Viewing:
                           *          (0-?)
   

Site:




 

       Public    Restricted
        Please designate your site as either public or restricted.  Public indicates your site is open to
        the public for viewing.  Restricted means your site is closed to the public.  Either way, your site
        will NOT be posted on CDLHN’s or DL Networks' website.  However, if participants call
        DL Networks to find a site in their area, they will only be notified of sites listed as "Public."
 
 

      As a non-profit organization, CDLHN faces funding challenges every year. 
      In order to continue offering free programming, it’s necessary we gather
      data from sites that participate in our broadcasts and report back to our
      funding sources on participation in these high cost productions. 
      Completing the post broadcast Site Facilitator Report, will help ensure
      CDLHN can continue to provide informative trainings at no cost to
      downlink sites.

        I agree to complete a Site Facilitator report.

        I would like to receive a copy of the data on this broadcast.
   

Select Site Type:

 

        
      Videos will be available for $30 through CDLHN 3-4 weeks following the live broadcast. 
        Visit www.cdlhn.com for more details.
   
          If Military or Federal digital Warrior/GETN satellite site, please complete next two boxes. 

CDV/ Convergent Site ID:
 

       (Example: AG-123B or AY-006A)  
        (ANG sites are requested to use their "B" IRDs if available)
 

IRDs:

       (Example:  2750320-6)
   

Additional Site Information:
 

      
        Please note that DL Networks does NOT track the number of seats available at your site. 
        The purpose of this information is to give the attendee an idea of the size of your facility.
        You may use this area to enter information specific to you site (i.e.: driving directions,
        parking instructions, special instructions, etc.)      
   

Additional Comments: