International Association of Undercover Officers
Mail Form and Payment To: 
International Association of Undercover Officers (IAUO)
142 Banks Dr
Brunswick, GA  31523
Or Fax To:    912-525-3053 or 800-876-5912

ADVANCED UNDERCOVER TECHNIQUES AND SURVIVAL
Registration Form
  Daytona Beach, FL     March 9 - 13, 2009
      Please print and complete this form.

If you prefer this form in Word Document format, click here !


Name:
________________________________________
Title:
________________________________________________

Agency:
___________________________________
Unit:
__________________________________________
Agency Address:
_______________________________________
City:
_________________
State: ______

Country:
_______________________________________		 Zip Code:
_________________
 

Work Phone:
( _______ ) _____________________________
Cellular:
( ______ )________________________________________

Fax Number:

( ______ ) __________________________

E-Mail:

___________________________________________

Payment Method:
Purchase Order #: ____________
($525.00) Tuition (Attach copy of P.O.)
Credit Card ($475.00)
(   )  Visa
(   )  Master Card Number:

#:  ____________________________________

Expiration:

______________

Signature:
_________________________________________________		      


(   )  Check ($475.00)       (   )  Money Order Enclosed ($475.00)       (   )  Will Pay at Registration ($475.00)  

Make all Checks, Money Orders or Purchase Orders Payable to:
International Association of Undercover Officers (IAUO)

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Copyright 2004, International Association of Undercover Officers, Inc.   All rights reserved