Instructor Sponsor Course Booking Form IS Course Booking Form Instructor Sponsors use this form to request courses with the WMA office. Course InformationIS Company Name*What is your company name - enter just your name if you don't have a company name. Is there a 3rd Party Sponsor?Who are you contracting with for this course?Course Type*8-Day WFR7-Day WFR5-Day WFROpen RecertWAFABridge(WAFA to WFR)WEMT UpgradeWALSRecert (2-day)Course Start date* Course End Date* Is this course Open Enrollment?*Would you like this course to be listed on our website for the public to view?YesNoCourse Location*Where is the course taking place? City State / Province / Region ZIP / Postal Code Certs Shipping AddressWhere do you want the certificates sent? Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Course ContactWho should the WMA office & instructors contact with questions?Name* First Last Email PhoneInstructorsInstructor of Record Name* First Last Other InstructorsOpen Enrollment InformationCompany name to be listed on the WMA websiteTypically this is your company name OR the 3rd party you are contracting with.Company Website LinkWhat is the link for the above listed company's website? Student Enrollment Contact Name*Who should the students contact to enroll in the course? First Last Student Enrollment Contact Email Address*Who should the students contact to enroll in the course? Student Enrollment Contact Phone #*Registration Method*Use WMA's 'pre-registration' form on our website - the enrollment contact will receive an email of interest from students once completedUse your own website for registration (please enter web address below)Web Address for Student registration* Course TuitionCourse Tuition OptionsDifferent prices for food/lodging included? Discounts for students/members?Lodging/Food InformationAre you offering food/lodging to students? What are you offering?Registration InformationIs there a deadline? Other registration instructions?Short Course BlurbOne sentence on what makes your course unique from other WMA courses. For Example: Description of the course location/ammenities. 200 Character maximum.NameThis field is for validation purposes and should be left unchanged.