(Print this web page and complete the form)

REGISTRATION FORM

Status (check all that applies)

    MAI       SRA       SRPA       RM

    Candidate      Affiliate      Other  

Name ___________________________________

Company ________________________________

Mailing Address __________________________

City/State/Zip ____________________________

Business Phone ___________________________

Fax Phone ________________________________

Social Security Number ______________________

 

SEMINAR FEE                   $150.00

 

    Check Enclosed

 

 

 

    Charge to:            VISA               Mastercard

 

Credit Card No. ____________________

Expiration Date _____________________ 

 

Name on card (Please Type or Print)

Signature  

________________________________________

 

 

Please make you check payable and return to:

Iowa Chapter of the Appraisal Institute

Wayne Hennessey, Executive Secretary

 

4287 Panorama Drive       Panora, IA 50216

 

Or FAX: 515-439-2349

 

 

Cancellation Policy: Registration deadline is July 14, 2000. Fees will be refunded in full up to 14 days prior to the meeting. Cancellations received within the 14-day limit, but prior to 48 hours before a meeting shall be refunded at a rate of 50 percent of fee charged. No refund shall be payable for cancellations received within 48 hours of the meeting.