The Nielsen Environmental E-School Group Discount Program Enrollment Form

Transcription

1 The Nielsen Environmental E-School Group Discount Program Enrollment Form A. Fundamental Requirements for the Group Discount Program This form must be completed to create a group discount account with the Nielsen Environmental E- School. This will facilitate registration of individuals who are part of a group of 5 or more people from a single entity (private company, government agency or other organization) that is seeking to use the online training services provided by The Nielsen Environmental E-School. Groups with fewer than 5 people do not qualify for the discount offered by this group program. Individuals from different companies or organizations cannot form a single group to participate in this group program. B. Group Account Point of Contact Information Please provide all requested contact information for the key contact person for this group: Group Contact Person: Title: Company/Agency Name: Complete Mailing Address: City, State/Province: Zip Code/Postal Code: Fax: (Be sure that your system will accept correspondence from Nielsen Environmental Field School and Nielsen Environmental E-School: info@envirofieldschool.com or envirofieldschool@yahoo.com) 1

2 C. Select the Type of E-School Training You Want You may register the individuals in your group to take either individual E-Modules or E-Courses. You cannot combine E-Modules and E-Courses under one discount account for the group, but a group can have one account for E-Module-based training and a second account for E-Course-based training for its staff. E-School Individual E-Modules (40 to 90 minutes each) E-School E-Courses (packages of from 13 to 32 modules each) E-Courses with the option to apply for certification E-Courses without the option to apply for certification Select one option or the other for E-Courses with or without the option to apply for certification; they cannot be combined. If some in your group want the certification option and others don t, sign all up for E-Courses without the option without certification; individuals who want to apply for certification may then do so separately at an additional cost. D. Tell Us Who is Authorized to Participate in E-School Training as Part of Your Group Please provide the names and contact information for the individuals you are registering for your group. Please let us know if any of these individuals are at a location different from that listed in section B of this form, and provide their complete contact information. A minimum of 5 individuals must be registered. Participant #1: 2

3 Participant #2: Participant #3: 3

4 Participant #4: Participant #5: If necessary, please copy this page and use additional pages as needed to register more than 5 of your staff for this program. 4

5 Using the information contained in Section D of this form, we will manually create personalized E-School accounts for each registrant. Upon payment of registration fees in full, each registrant will receive a unique ID and password to access their individual account and begin the E-School E-Course or E-Module. IDs and passwords cannot be transferred to other members of the company, agency or organization. Completion certificates and CEUs will only be issued in the registrant s name, according to their unique ID. Each individual will have 30 days to complete an E-Course and 24 hours to complete an E- Module. Extensions of time (in weekly increments) to complete E-Courses may be purchased (by credit card only) at a cost of $100/week, by calling us at (575) (between 8 a.m. and 5 p.m. mountain time). No discounts can be applied to time extensions. E. Payment Methods Prepayment is required for all group registrations. Payment can be made by check or credit card (Visa, Master Card or American Express) for E-Modules or E-Courses. For payment by check, we will an invoice, showing the 20% discount and the balance due, to the account s primary contact person (identified in Section B of this form). E.1. Calculate the Amount Due Option 1: E-Modules Only (Consult our Course Catalog for E-Module numbers and names) All E-Modules are a fixed price of $159.00* US each. Number of people listed in Section D of this form (5 minimum) x number of E-Modules per person x $159.00* = Total Due Group members are free to select which E-Modules they would like to take unless you have a specific requirement. If so, please indicate which E-Module(s) is (are) required for your group: 5

6 Option 2: E-Courses With two exceptions, our E-Courses can be taken without (Option A) or with (Option B) the option of certification. Option A** Option B*** The Complete Ground-Water Monitoring E-Course (29 Modules) $ * $ * The Ground-Water Monitoring Well Design, Construction and Development E-Course (14 Modules) $ * $ * The Complete Ground-Water Sampling E-Course (15 Modules) $ * $ * The Low-Flow and No-Purge Sampling E-Course (13 Modules) $ * N/A The Environmental Sampling E-Course (32 Modules) $ * $ * The Complete Soil Sampling E-Course (17 Modules) $ * $ * The Soil Sampling for VOCs E-Course (15 Modules) $ * N/A Notes: All prices are in US dollars. **Option A is for those who wish to take an E-Course without the option of applying for certification. Study Guides (which include hard copies of all PowerPoint presentations, supplemental materials, and extensive reference lists on each topic) may be purchased as an option for $ each (includes shipping via Federal Express, except for AK, HI and International locations contact us for a quote for shipping to these and specific International locations) ***Option B is for those who wish to take an E-Course with the option of applying for certification. Price includes a Study Guide and certification exam fees. N/A = certification option not available for this course. 6

7 Calculate E-Course Registration Fees: E-Course Unit Number of Total Name Cost Participants Due+ For Example: Low-Flow/No Purge $ $6, Your 20% discount will be applied when the initial transaction is processed to your credit card. If paying by check, an invoice will be generated showing all discounts applied. Prepayment is required before access codes are assigned to your staff. Credit card payments are subject to a 5% service fee. Calculate Optional Study Guide Fees (not applicable if taking a course for certification): : E-Course Name Unit Cost* Number of Guides Total Due* $ * Additional shipping charges for deliveries to AK, HI and International locations will be applied at our cost. 7

8 E.2. Provide Payment Information Payment must accompany this Group Discount Program Enrollment form. We are pleased to offer you the following payment options: Payment by Check. Please make payment in US Dollars to: Nielsen Environmental Field School and mail your payment along with this form to: The Nielsen Environmental E-School ATTN: Group Discount Program 9600 Achenbach Canyon Road Las Cruces, NM Payment by Credit Card. For your convenience, we can accept payment using any of the following credit cards (a 5% service fee applies): Card Number: Name on the Card: Expiration Date: 3-Digit (or 4-Digit for AmEx) CVV Security Code: Billing Address for the Card (this may be different from the office address): F. If You Need to Add Additional Staff to an Existing Account You can add individuals to your group account. Simply contact us via to request the additions, and we will get your additional staff added to your account promptly. Your application to create a group discount account for your group is now complete. You will receive confirmation of creation of your account from us via . Upon our receipt of your payment, individuals listed in this form will receive their unique access codes via . Thank you for your participation in the Nielsen Environmental E-School! 8