Registration Form – IMESAFRTraining

Pleasetypeorprintclearly.Pleasecompleteadditionalformsifregisteringmorethanoneperson.

All Prices are in USD.

Course Date/Location: / 11-13 April 2018
w/AN Module & Upgrade 2.0 to 2.1 Training 18 April 2018
Ottawa, Canada (Venues TBD)
IMSAFR 2.1 Training
[ ] New Voucher $2100
[ ] Refresher Training $1600
[ ] Pre-paid Voucher $0 / Software
[ ]Regulator Evaluation Copy $0
[ ]IME Comp Copy $0
[ ]IME Upgrade $375
[ ]Non-IME Upgrade $750
[ ]IME New Copy $750
[ ]New Copy (Non-IME) $1500 / Half-Day Training Modules*
[ ] AN Module** $350
[] Pre-Paid AN** $0
[ ]Upgrade 2.0 to 2.1
Training $350
[] Pre-paid Upgrade $0
*Both classes will be held April 18, 2018; Non-concurrent; Times and Venue TBD
**Previous 2.0 or 2.1 training required to attend / Total
$______
Name
(title,first, middle, last):
U.S.Citizen:
[ ]Yes [ ] No / If “No”, identify country ofcitizenship
Organization:
Address:
City/Street/Zip:
Phone:
E-mail:

PaymentInformation:

Payment of fee is due at time ofregistration.

[ ] Check: Please make checks payable to: A-P-T Research, Inc.

[ ] Visa/MC: Copy and paste the following URL into your browser to pay by card.

[ ] Prepaid Training Voucher

Sendregistrationandfeeto:

A-P-TResearch,Inc.

Attn:Mary Robinson

4950ResearchDrive

Huntsville,AL35805

Telephone: (256) 327-4034

e-mail:

CancellationPolicy:Ifyouareforcedtocancelyourreservationsafter payment of the fee, you will be entitled to transfer the license to a later class or a 50% refund until two weeks prior to the class date. No refunds are available if requested less than 15 days prior to class date but substitutions can be arranged. Contact Mary Robinson for more information.

A-P-TResearch,Inc.4950 ResearchDrive

Huntsville, AL35805