APPA / NARI Order Form

(please print and complete)
Title  


Member Price
Qty.
 Total
Safeguarding Your Career program, including 5 CME credits
$200
HIV/AIDS Education program, including 3 CME credits
$90
Domestic Violence program, including 1 CME credit
$90
Medical Ethics program, including 2 CME credits
$90
OSHA Compliance System
$130
Annual OSHA Training program
$40
Payment Options
Payment Enclosed. (Make checks payable to: TIV, Inc.)
Total

Charge my:

Visa Mastercard American Express

Please Note
To receive discount prices this Order Form must accompany your order or call Member Services (800) 221-2168 ext. 5.

Be sure to have your Order Form in hand with your credit card when you call.
Account#
Expiration Date:
Name of Cardholder:
  
Telephone: ()
Signature:
Ship to:
Mr./Mrs.:
Association:
Adress:
City/State/Zip:
Telephone:() Fax: ()
Signature:

Please complete entire Order Form and mail with payment to:

Association Services
350 Fairway Drive Suite 200
Deerfield Beach FL 33441-1834

Fax Order Form to (954) 571-8582.