Delmar Learning -- Course Trial Run Form

Online Courseware Trial Request Form

Instructors, trainers or sales reps may complete this form to receive complete access to Delmar Learning's Online Course for a trial period. Once your status as an instructor has been verified, you will recieve an e-mail containing a URL and instructions on how to access your trial account.

* = Required Fields. Your request cannot be processed if the required fields are not completed.

Request Information
Requested Course Author/Title:*
Instructor / Trainer First Name:*
Instructor / Trainers Last Name:*
Institution or Company:*
Customer Type:*
Department: *
Enter Your Sales Reps Name:
Contact Information
Street:*
City:*
State:*
Zip:*
eMail Address:*
Contact Phone:*
Course Information
Total Expected Enrollment:
Expected Course Start Date (mm/dd/yyyy):
Expected Course End Date (mm/dd/yyyy):
Additional Comments