Registration Form for Certified Microbial Investigator/Consultant (CMI/CMC) Course
(This is not the application for the CMI/CMC 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 Microbial Investigator/Consultant 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 CMI Course
Note: There are prerequisites for CMI Certification. Details and the CMI Exam Application are available by contacting the American Indoor Air Quality Council (AmIAQC) at 1.800.942.0832.

Certified Microbial Investigator/Consultant (CMI/CMC) 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 -- $745 Non-Members -- $870

This Registration Form is for the CMI/CMC Course only. This is not the application for the CMI/CMC Certification Exam. Please contact the American Indoor Air Quality Council (AmIAQC) at 1.800.942.0832 for CMI/CMC Certification prerequisites, exam application, 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