Online Training and Competency Order Form

    Date Submitted & Year For Enrollment

  • Identification Information

  • Contact Information Of Person Completing This Form

  • MTS Training Courses

  • To order Training Courses fill in appropriate circle below. Note: The minimum order is two modules.
  • Item #s: List below • Price: $100.00 (per module)
  • Item#: PT80000 • Price: $500.00
  • You will receive All Training Courses
  • MTS Competency Tests

  • To order Competency Tests fill in appropriate circle below. Note: The minimum order is two modules.
  • Item #s: List below • Price: $100.00 (per module)
  • Item#: PT81000 • Price: $500.00
  • You will receive All Competency Tests
  • Combination of Both Training Courses and Competency Tests

  • To order modules in combination fill in appropriate circle below. Note: The minimum order is two modules.
  • Item #s: List below • Price: $100.00 (per module)
  • Item#: PT80900 • Price: $800.00
  • You will receive all of both Training Courses and Competency Tests
  • MTS Point of Care Competency Assessment

  • To order MTS Point of Care Competency Assessment fill in appropriate circle below.
    Order “w/T&C” product if ordering with Training Courses and/or Competency Tests.
  • Item#: PT81900 • Price: $300.00
  • Item#: PT81903 • Price: $200.00
  • Item#: PT81910 • Price: $300.00
  • Item#: PT81913 • Price: $200.00
  • Additional fees apply if facility has more than 30 users per WSLH PT ID# (Item#: PT80910)

  • If facility has more than 30 users complete information below.
    Quantity is per 100 users (i.e. 31-100 users [Quantity = 1]; 101-200 users [Quantity = 2], etc.)
  • X $100.00 (unit price)
  • Total Order Price

  • Indicate Method Of Payment

 

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