Distance Learning Revision Request

THIS FORM SHOULD ONLY BE USED IF YOU HAVE ALREADY COMPLETED A DISTANCE LEARNING PROGRAM REQUEST FORM OR HAVE ALREADY RECEIVED YOUR VISIT CONFIRMATION.

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* 1. Group OR Facility Name:

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* 2. Name of the person on the original program request:

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* 3. Phone Number:

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* 4. Email Address:

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* 5. I have recently submitted a Distance Learning Program Request Form -

I am waiting to receive my confirmation email.

I have already received my confirmation email. (Please enter your reservation code in the comment field below.)
Reservation Code: (Starts with "SM###" and can be found in your confirmation email.)

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* 6. I have received a confirmation with my Program date as:

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* 7. I am requesting a change to our: (check all that apply)

Technology Check Date or Time

Program Date or Time

Program Subject

Other (Number of programs, etc. Please specify)

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* 8. Please describe the nature of your request:
(ie. If you are requesting a new date or time, please provide us with your new choice dates and/or times here.)

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* 1. Group OR Facility Name:

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* 2. Name of the person on the original program request:

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* 3. Phone Number:

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* 4. Email Address:

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* 5. I have recently submitted a Distance Learning Program Request Form -

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* 6. I have received a confirmation with my Program date as:

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* 7. I am requesting a change to our: (check all that apply)

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* 8. Please describe the nature of your request: (ie. If you are requesting a new date or time, please provide us with your new choice dates and/or times here.)

* 8. Please describe the nature of your request:
(ie. If you are requesting a new date or time, please provide us with your new choice dates and/or times here.)