Sponsor Questionnaire

	Please verify the information in the following questionnaire by filling in the blanks on a return e-mail. Your contract will follow upon receipt as a PDF file when final dates have been agreed upon and an instructor scheduled. If you choose, your course will appear on our web site after we receive a signed copy of the contract and flyer(s) will be sent to you as pdf file(s). Books and course materials will be sent when we receive your deposit. A pdf course syllabus will be sent to you at this time as well. Details on sponsoring a medical course can be found at https://www.wildmedcenter.com/how-to-sponsor-a-medical-course.html

In order to help us avoid confusion please delete any information that does not apply to your course in your return e-mail. Thanks.

Please answer the following questions:
Is your course open to the general public?

Sponsor Information
Full Name of Course Representative: 
Name of Sponsoring Organization:
US Postal Shipping Address:

UPS Shipping Address:

Nearest Airport for instructor/student pick-up:

Phone: 
E-mail:

If you have a page on your website discussing your WMTC course we will link to it if you provide the URL below. A web page dedicated to your WMTC course discussion the location, lodging options etc. with links to a registration form or specific letters can help reduce your workload in addition to help sell your course. For effective student communication your page should link back to us. 

Class page URL:

Course 1 Information
Course: 
Location: 
Dates: 
Course Start (date & time): 8 AM 
Course End (date & time): 6 PM 

Course 1 Marketing Information
Pricing for Public Enrollment Courses listed on the WMTC web site. If you DO NOT want your course listed on our web site, please delete this section in your return e-mail.
Course Cost:
Discount for early registration and cutoff date:
Full Payment is due by:
Refund Policy:

What is included in the course cost:
Extra costs (housing, food, etc.):
What credit cards will you accept:
Make checks payable to:

Public Contact Information (if different from Sponsor Information above)
Contact Person:
Contact Phone:
Contact E-mail:
Contact Address:

Payment Options
Please indicate the method of payment you wish to use:

____ international bank wire transfer

____ check, money order, or certified bank check. You will receive an pdf file invoice via e-mail and are responsible for payment according to the time lines indicated in your contract.

____ credit card. If you choose this option a 3% surcharge will be added to your final balance. The money goes to the credit card company responsible for processing your credit card; in this case, PayPal. Choosing this option indicates your willingness to pay the surcharge. You will receive an e-mail invoice with a button linking you directly to the PayPal website for processing.

If you have any questions please e-mail or call. I look forward to hearing from you shortly. Have an excellent week.

Cheers, 

Paul Nicolazzo
Director
Wilderness Medicine Training Center ~ International
www.WildMedCenter.com
Phone: 509-996-2502