Host Information

Please answer all the questions below. This information will help us manage the course, and will appear on the website for the participants.

  • Please provide the name, email and phone number for the point of contact for the course.
  • Please enter the address where the course will be held. Include any suite or rooms numbers.
  • Please provide the mailing address and contact person, if different from above. This will be the location where we ship the course supplies. (Needles, gloves, sharps containers, booklets, etc.)
  • Please enter a number from 1 to 30.
  • Please list 1-3 hotels near the venue. If you are reserving a block of rooms or have a corporate rate please include information on how people can reserve the rooms.
  • Please let us know any other information about the venue or the area that will be helpful to the participants.
  • Please upload a picture of the room where the course will be held.