DATIA Course Registration

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Choice Dates Supervisor Training ----- February 21, 2012 – Las Vegas, NV 1pm-5pm April 18, 2012 – San Antonio, TX 1pm-5pm April 21, 2012 – San Antonio, TX 1pm-5pm September 18, 2012 – Atlanta, GA 1pm-5pm Ins & Outs of Drug Testing ----- February 21, 2012 – Las Vegas, NV 8am-12pm February 22, 2012 – Las Vegas, NV 1pm-5pm April 18, 2012 – San Antonio, TX 8am-12pm September 18, 2012 – Atlanta, GA 8am-12pm September 19, 2012 – Atlanta, GA 1pm-5pm CPCT Course ----- February 23, 2012 – Las Vegas, NV February 24, 2012 – Las Vegas, NV April 18, 2012 – San Antonio, TX April 21, 2012 – San Antonio, TX September 20, 2012 – Atlanta, GA September 21, 2012 – Atlanta, GA MRO Assistant ----- February 22, 2012 – Las Vegas, NV April 18, 2012 – San Antonio, TX April 21, 2012 – San Antonio, TX September 19, 2012 – Atlanta, GA Advanced Drug Testing Management ----- February 21, 2012 – Las Vegas, NV February 22, 2012 – Las Vegas, NV April 18, 2012 – San Antonio, TX April 21, 2012 – San Antonio, TX September 18, 2012 – Atlanta, GA September 19, 2012 – Atlanta, GA DER Course ----- February 23, 2012 – Las Vegas, NV April 18, 2012 – San Antonio, TX April 21, 2012 – San Antonio, TX September 20, 2012 – Atlanta, GA Alternative Specimen ----- February 22, 2012 – Las Vegas, NV 8am-12pm April 18, 2012 – San Antonio, TX 1pm-5pm April 21, 2012 – San Antonio, TX 8am-12pm September 19, 2012 – Atlanta, GA 8am-12pm Notes:

	Course and Workshop Registrations	Number	Fee*	Total
	Ins & Outs of Drug Testing		$389
	Supervisor Training		$389
	Certified Professional Collector Trainer Course		$389
	MRO Assistant Course		$389
	Advanced Drug Testing Management		$389
	Designated Employer Representative Course		$389
	Alternative Specimen		$389
	Total Number of Unique Attendees
	Discount for attendees with two or more courses**		-$50
	Subtotal of Registrations
	**When you register for two or more of DATIA's industry training courses or workshops, this form will deduct $50 from the total fee. All registrations must be on this one form, with payment. Cancellation Policy Cancellations made at least 30 days before the program will receive a full refund; cancellations made at least 14 days before the program will receive a full refund less a $50 administrative fee; and cancellations made less than 14 days before the program are nonrefundable. All refund requests must be submitted in writing. DATIA reserves the right to cancel any and all courses 30 days prior to the date of the course(s) if five or less people are registered for any DATIA course. DATIA will refund the course fee or offer a credit to attend the course at any date or location offered by DATIA within a year from the cancelled course date. DATIA will not incur any hotel or travel costs of attendees from a cancelled course. For any further questions regarding this policy please contact DATIA at 800-355-1257.

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You may also fax this form to 202-315-3579 or mail it to 1325 G Street, NW, Suite 500-#5001 Washington DC 20005
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