IALEFI Master Instructor Development Program
Cortland, NEW YORK - July 30 - August 1, 2012

NAME_______________________________________________________________________________________________

AGENCY_____________________________________________________________________________________________

ADDRESS____________________________________________________________________________________________

CITY____________________________________________________________STATE________ZIP___________________

MAILING ADDRESS____________________________________________________________________________________

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CONTACT PHONE_________________________________________FAX________________________________________

E-MAIL ADDRESS_____________________________________________________________________________________

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REGISTRATION FEE*:
Member $225.00 ________
Non Member $280.00 (includes 1 years membership)_________________

Return to :
IALEFI
25 Country Club Rd, St 707,
Gilford NH 03249,

FAX 603-524-8856
Email: ljdavis@ialefi.com

(*Cancellation: Any cancellations after the registration has been processed may incur a 5% processing fee.)