Registration Form for Certified Indoor Environmentalist (CIE) Course
(This is not the application for the CIE Certification Exam)
TO REGISTER, PRINT OUT THIS FORM AND FAX OR MAIL BACK TO INDOOR SCIENCES, INC.

1. Fill out the Registration Form for Certified Indoor Environmentalist Course.
2. The Registration Form must be signed and dated by the applicant. It should be submitted with course fees.
3. Admittance to the course may be denied if full payment has not been received two weeks prior to the course date.
4. This Registration Form, remittance, and all correspondence should be directed to:

Indoor Sciences, Inc. • 105 W. Madison St. • Ste 802 • Chicago, IL 60602 • Fax (312) 637-9393

5. There are no prerequisites for the CIE Course
Note: Although there are no prerequisites for the course, there are prerequisites for the certification exam. Contact the American Council for Accredited Certification (ACAC) for details. Also contact the ACAC to download a certification application. The ACAC's phone number is (888) 808-8381 and website is www.ACAC.org.

Certified Indoor Environmentalist (CIE) Course Registration Form
Your Name _______________________________________________________________
Name to appear on name tag _______________________________________________________________
Company Name _______________________________________________________________
Address _______________________________________________________________
City _______________________________________________________________
State _______________________________________________________________
Zip _______________________________________________________________
Daytime Phone _______________________________________________________________
Fax _______________________________________________________________
E-mail _______________________________________________________________
Course Date _______________________________________________________________
Course Location _______________________________________________________________
FEES
Course Fees IAQA Members -- $820 Non-Members -- $945

This Registration Form is for the CIE Course only. This is not the application for the CIE/CIEC Certification Exam. Please contact the American Council for Accredited Certification (ACAC) at (888) 808-8381 for information regarding prerequisites, exam applications, and exam fees.
Make checks payable to "Indoor Sciences, Inc. "  Or pay by credit card by completing below:
 
Credit Card (circle one): VISA    MasterCard    American Express
 
Amount to Charge $____________
Card Number ________________________________________________
Expiration Date ____________________
Name on Card ________________________________________________
Billing Address ________________________________________________
________________________________________________
Signature ________________________________________________
Cancellation and Refund Policy: Written cancellations are accepted up to 14 days before the class date. Refunds will be made for cancellations received up to 14 days before the class date, less a 10% processing fee. Cancellations received less than 14 days before the class date will not be refunded. However, fees remitted may be applied toward a future class within 6 months, if available. A 10% processing fee will be applied when rescheduling a class.
Applicant Signature _________________________________ Date_______________
RETURN THIS FORM AND PAYMENT TO:

Indoor Sciences, Inc. • 105 W. Madison St. • Suite 802 • Chicago, IL 60602
Phone (312)920-9393 •  Fax (312)637-9393