C.P.M. Class Reservation Form

C.P.M. Class Reservation Form

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About NAPM-AZ

About ISM

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I plan to attend the C.P.M. Review Course(s)

Member Yes No

Name

Company

Work Phone #

Home Phone # required field

Email

Birthdate required field

Module 1 - November 10, 2007

Module 2 - January 12, 2008

Module 3 - March 8, 2008

Module 4 - May 17, 2007

Cost Members - $175 per module

Non-Members - $225 per module

Payment deadline is 2 weeks PRIOR to each Module. If you register after the deadline, there is a $25 penalty fee added to the cost.

Payment Information Mastercard Visa American Express Diners ClubPayment in Mail

Name on card

Card # **Enter last 4 digits only if your Card is on file.
Due to security concerns, if your card is not on file, you MUST call (602) 253-6453 with your credit card information.

Exp Date (mm/yyyy)

Amount:

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You may also mail or fax payment to:
    NAPM-Arizona
    PO Box 31276
    Phoenix, AZ 85046-1276
    Fax #  (602) 493-2006

NAPM-AZ, Inc.