APICS Phoenix Chapter #58
Fundamentals Course Registration
Make Reservation Cancel Reservation
A separate Registration Form is required for each course!
* Registration is available after this date. It is listed for scheduling and In-house pricing purposes. ***COURSE WILL BE RESCHEDULED IF THERE ARE LESS THAN 5 PARTICIPANTS***
* denotes required field or selection
Name: *
Company Name:
Email:*
Mailing Address: City:State:Zip:*
Phone#:* Fax#:
Member Type:*
* NOTE: The fees noted below do not include the mandatory Participant Guide, which must be ordered separately from APICS Society.
APICS or ISM or IMA MEMBER - $350.00 Member#:Exp: 01-JAN 02-FEB 03-MAR 04-APR 05-MAY 06-JUN 07-JUL 08-AUG 09-SEP 10-OCT 11-NOV 12-DEC 2005 2006 2007 2008 2009 2010 Membership number must be provided.
STUDENT MEMBER - $150.00 Member#:Exp: 01-JAN 02-FEB 03-MAR 04-APR 05-MAY 06-JUN 07-JUL 08-AUG 09-SEP 10-OCT 11-NOV 12-DEC 2005 2006 2007 2008 2009 2010 APICS or ISM Student Membership number must be provided.
NON-MEMBER/Enclosing Application - $375.00 Membership application and separate check or a copy of previously submitted membership application must be included.
NON-MEMBER - $450.00
Payment Type:*
Please Charge My: <Select One> VISA MasterCard Card #: Exp: 01-JAN 02-FEB 03-MAR 04-APR 05-MAY 06-JUN 07-JUL 08-AUG 09-SEP 10-OCT 11-NOV 12-DEC 2005 2006 2007 2008 2009 2010
Note: The Chapter can not provide a secure data transmission at this time. As alternatives: 1) If you have previously registered for a class and paid with a credit card, note "Credit Card on File" in the comments below; or 2) If you have not previously registered for a course, submit the on-line registration form without your credit card number. Print out your registration confirmation form, note your credit card number on the form, and fax it to the Chapter's dedicated fax line at (480) 813-2154.
Pay By Check - Payable to: APICS Phoenix Chapter #58
Comments or Questions:
By submitting below I acknowledge that I have read the cancellation policy and agree to abide by its terms and conditions. In addition, I authorize the chapter to accept payment or charge my account as noted above.