Please complete the following application and continue through the payment portal. Do you have an active membership? *YesNoAre you registering for the 40 Hour Certification or Recertification class? *40 Hour Certification ClassRecertification ClassWhich class do you wish to attend? *Name(s) of Applicants Attending *Number of Applicants Attending *12345678910Department or Organization *Street Address *Division, suite, etcCity *State *ZIP / Postal Code *Email Address *Phone Number *Which instrument do you use?Vipre SystemsCVSA* DisclaimerI {name-1} {name-2} certify that all information contained in this application is complete and true to the best of my knowledge. I understand that any material omission, misrepresentation or falsification of this information is grounds for dismissal or refusal of membership to the IAVSA Association. I hereby authorize investigation of all statements contained herein and give permission to contact any or all of my previous employers, references and/or schools attended for information.I Understand and agree to all terms Listed aboveClass DuesMembership Payment *Check By MailPlease InvoicePayment InformationPlease Make Checks Payable to: IAVSA, LLC James M. Hamilton, Secretary-TreasurerPO Box 23211Barling, AR 72923Invoice InformationIAVSA will submit an invoice to: "{name-5}" Please select "Submit Registration" to complete your registration.Submit Registration