Registration Form for SITE FACILITATORS

(Individuals Desiring CE Credits Must Register Separately)    Register Here   Use "Guest" as ID and Password at Log-In screen

Use this form to register as a Site Coordinator for a Satellite Downlink (Satellite one way video and two way audio) or as a Site Coordinator for a Terrestrial VTC Link (see "Site Type"  Selection Box below.)

(If you experience server problems when submitting this form or if you need assistance locating a viewing site, please call 888-820-4898 toll free for further assistance.)

Please provide the following contact information:  (* indicates required field)

Event Information (Multiple selections allowed, hold control key down during selections)
Events Date(s)
  Need to review Event Description? Visit this web site: 

 http://www.cs.amedd.army.mil/ddl/bmtc07/BMTC07.html
 
Estimated Live Audience *
Estimated Videotape Audience * (0-?)
POC/Site Facilitator Name (First and Last)*
Phone (Commercial Not Autovon, Include Area Code )*
E-mail *
Fax   (Commercial; For Alternate Contact Purposes)
Technician's Name (if different than POC/Site Facilitator ).
Technician's Phone (if different than POC/Site Facilitator ).
Technician's Email (if different than POC/Site Facilitator ).
Organization *
City *
State *
Zip Code *
Site Type
Terrestrial VTC Connectivity Available to Federal and Military Sites ONLY!
Satellite Site ID (example: ANG-123 or DLN-012) Military/Federal Sites Only
IRD(s) Military Sites Only
Additional Comments:

Call 877-820-0305 if you need further assistance

Hit Counter Hits since 14 Jan 2007.
Last revised: February 05, 2007
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Distributive Learning Networks
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