Advanced Cargo Course Registration Information

                   

Advanced Cargo Course   

Print out the following page and either mail it in with a check payable to American Institute of Marine Underwriters, 14 Wall Street, New York, NY or fax with Credit Card Information filled in below to fax number: (212) 227-5102.

 
First Name:  
Last Name:  
Title:  
Company:  
Business Address:  
City:  
State:  
Zip Code:  
Telephone:  
Fax:  
Email Address:  
License #:  
(Last 4 digits of your SS# is needed for New York - this can be given at the course)
 
Tuition is: $200.00 for one session
                 $300.00 for both sessions

Registering for:   r Both Sessions   r Underwriting Only    r Claims Only
 
Number of Participants:  
Total Fee Paid:  

Method of Payment
Check:  Please make payable to:  American Institute of Marine Underwriters
            (please note student's name and course on check stub)

Credit Card (Circle One)     MasterCard      AMEX    Visa    Diners
 

Cardholder Information
First Name:
Last Name:
Card Number:
Exp. Date: