– For Fax or Mail-in Registration Only –

PAPA Fax or Mail-in Registration Form
QAC Exam Prep. Course
Please print out a copy of this form for each person registering, fill in all necessary details, and mail along with payment information for total amount due to:
Mail to: PAPA, P.O. BOX 80095, Salinas CA 93912-0095
PHONE 831-442-3536 FOR INFORMATION
FAX 831-442-2351 CREDIT CARD PAYMENTS ONLY

$200 = QAC Exam Prep. Course - Early registration per person, per location.
Postmarked no later than 10 days prior to meeting.
$225 = QAC Exam Prep. Course - Late registration per person, per location.
After early registration is closed.
INDIVIDUAL PAPA MEMBERSHIP ANNUAL DUES
2004 MEMBERSHIP YEAR(1/1/2004 -12/31/2004) ANNUAL DUES = $30
2005 MEMBERSHIP YEAR (1/1/2005 -12/31/2005) ANNUAL DUES = $35

PLEASE WRITE YOUR LICENSE # ON YOUR CHECK
NO PURCHASE ORDERS WILL BE ACCEPTED FOR MEMBERSHIP FEES

Please fill in the following information:

List Seminar Location(s):

Seminar ______________________________

Seminar ______________________________

___ Check here if paying for membership only.

Individual PAPA Membership Annual
Dues for calendar year:

____ 2004 (1/1/04-12/31/04) = $30
____ 2005 (1/1/05-12/31/05) = $35

Total fees enclosed:    $ __________________

PCA, PILOT, QAL or QAC License #:

_____________________________________

Name:________________________________

Address:______________________________

City/State/Zip __________________________

Daytime Phone:_________________________

Home Phone: __________________________

Cell or Fax Phone:  ______________________

Payment Information:

___ Visa ____ Mastercard_ Exp. __________

#: __________________________________

Name on card: ________________________

E-mail Address :_______________________

Signed:  _____________________________

If paying by check or money order:

Check or Money Order No.:

____________________________________

REGISTRATION IS FINAL, THERE WILL BE NO REFUNDS


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