General Information  (* indicates a required field)

*First or Given Name:

*Last Name or Surname:

Job Title:

*Company Name:

*Company Address:

Address 2:

*City:

*State:

*Postal code:

*Country:

Choose Your Country United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antartica Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Diego Garcia Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Estonia Ethiopia Faeroe Islands Falkland Islands (Malvinas) Fiji Finland France French Antilles French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guantanamo Bay Guatemala Guernsey, C.I. Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey, C.I. Jordan Kazakhstan Kenya Kiribati Korea, Dem. People's Rep of Korea, Republic of Kuwait Kyrgyz Republic Kyrgyzstanu Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Island Mexico Micronesia, Fed. States of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherland Antilles Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Panama Canal Zone Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of Moldova Reunion Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saipan Samoa San Marino Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands, U.S. Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe

*Phone:

Fax:

*E-Mail:

Training Request

Request Date:

Number Of Students:

Student's Names:

(Class size limited 
to four to six students.)

Training Workshop.

Select One PB6500 PB3500 PB3000 PB2500 PB2000

Training Module(s).

Overview

Test Program

Probe Card Testing & Repairing

Configuration

Advanced Maintenance

Diagnostics

Training Location.

Customer Site    ITC Site

Dedicated Training
Room Available?

Yes    No

If training is to take place in a clean room, what rules should ITC observe?

Examples: 
Is makeup, after shave, or perfume allowed?

Is documentation required to be on clean room paper? (Additional Charge)

Special Request

Desired language.

English Chinese Japanese Korean Other

Interpreter required?

Yes    No

Typical probe card available?

Yes    No

Multiple sessions required?

Yes    No

Student's Experience

Level of Probilt 
experience?

Select One Competent Some None

Level of probe card
experience?

Select One Competent Some None

Level of computer
 experience?

Select One Competent Some None

Please describe any special arrangements that must be made prior to delivering the training workshop.

Example:
Are badges or security clearances required?