Advanced Protection & Indemnity Underwriting Registration Information

                   

Advanced Protection & Indemnity Underwriting Registration Information     

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 $350.00 per student for AIMU Members
Tuition is $500.00 per student for AIMU Members Agents & Brokers
Tuition is $650.00 per student for Non-Members of AIMU

 

Participation:      r Attend On-Site   r Distance Learning*
 
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: