Method of Payment
Seminar Registration Fee: (completed by PIA after EMailing)		=$___________________
Seminar Registration Fee: (completed by PIA after EMailing)		=$___________________
Total Education Investment enclosed:(completed by PIA after EMailing)		=$ __________________

 

ADA:
In accordance with Title III of the American with Disabilities Act (ADA), we invite all registrants to advise us of any disability and any requests for accommodation to that disability.  Please submit your request as far as possible in advance of the program.

Please complete the information in each section:
There are THREE ways to submit this form to us!

1. EMAIL
2. FAX
3. Regular Mail

Please PRINT this form when completed for options 2 or 3. Send your appropriate fees along with the completed form.  For Option 1, we will contact you regarding fee payment after receiving your EMAILED registration form.

Please CLICK "EMAIL Education Application"below.  We will receive a copy by EMAIL.   We will contact to arrange fee payment for the course you have selected.

Thanks for giving us the opportunity of being a part of your professional education and what you do through PIA of Tennessee!