Industrial Training Consultants, Inc.

Section 1 - Contact Information

Title	First Name*	Last Name*

Company*

Position/Title*

Address*

City*	State/Providence*

Zip/Postal Code*	Country*

Phone:*

Ext.

E-Mail*

Website:

Fax:

Section 2 - Information Request

I am interested in the following (please check all that apply):

e-Learning Program Development

Customized Operator Training

Customized Maintenance Training

Customized Safety Training

Electronic Performance Support

e-Xpert™ Troubleshooting

Puma Pathfinder Learning Management System

Train-the-Trainer Programs

Program Updates/Revisions, Conversion to e-Learning

Off-the-Shelf Programs
- Maintenance
- Petrochemical
- OSHA Safety
- Drilling Rig
- Refining
- Compressors
- Heat Exchangers
- Engine/Generators

Other

Section 3 - Contact Request

	Please call me to discuss my training needs.

	I would like to set up a meeting to learn more about ITC's services and products.