step 1: contact information · registration form information: call 1-888-900-8283 toll-free...
TRANSCRIPT
Registration Form INFORMATION:Call 1-888-900-8283 TOLL-FREE Email [email protected] Gardiner, MT, March 28–April 1, 2016
Please Mail OR FAX to: Fax: 970-484-8179 P.O. Box 2246, Fort Collins, CO 80522
Step 1: Contact Information
Step 2: Payment Options (Use only one method)
Step 3: Cost Options
Step 4: Eligibility
Name ________________________________________Badge Name____________________________________Job Title _______________________________________Agency________________________________________Phone _________________________________________FAX ___________________________________________
Email __________________________________________Address ________________________________________City ___________________________________________State __________________________________________Zip ____________________________________________
I have enclosed a check for $___________
I have enclosed a copy of my Purchase Order: P.O. Number _________________
Note: A copy must be provided with this form.
Please charge this Credit Card:
q American Express q Visaq Mastercard q Discover
Number: ____________________Expiration Date: ____________________Signature: ____________________
OR OR
q Check here for a list of other registrants for potential roommates or carpoolers.
Cost includes 5 days instruction, workshop materials, refreshment breaks, an NAI
in the cost for this workshop. You must hold a current individual membership to receive the member price.
q $625 - Current NAI members
q $700 - Non-members
PLEASE NOTE: Registration is not completed or guaranteed until payment is received with the necessary paperwork. There is a late fee of $75 for registering within one month of the first day of the course.A $75 fee will be charged for cancellations after that date. A $50 processing fee will be applied if you transfer at any time . to another workshop. Prices are subject to change without notice.
q CIM q CIP q CIT q CHI
must provide this information. Please indicate which type of proof you are attaching:
q transcript (not diploma)
q q
NAI Polo Shirt Selection
q Men’s q Women’s
q XS q S q M L q XL q 2XL
q Green q Blue q Purple q Burgundy q Tan q Turquoise (ladies only)q Pistachio (ladies only)