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Please complete the below form to pay for the course via check to be sent to the Chapter through the US Mail.
Last Name, First Name
Company Name
Address
City, State, Zip code
E-mail
Best contact Phone Number
Certification Course Registration
CPP- Member 300.00
CPP- NonMember 350.00
FPC - Member 225.00
FPC- Non Member 275.00
Reason for taking course
Certification Preparation
Re- Certification Hours
Payment Method
Company Check
Money Order
Personal Check
Check Number
Date of payment
Comments
Please PRINT this form prior to hitting send. Click the send button to provide us an alert payment is being mailed and reserve a space in the class. Mail payment and printed form to : Chicago Chapter 4740 N Cumberland Ave #355 Chicago Illinois 60656 Thank you!
