Application for 2004 ASPT CEU Membership Renewal

Manual and CEU Test Order Form
Last name ________________________________ First name ________________________________ Address ____________________________Apt. _____ City _____________________ State _____ Zip ______ Membership # (required) _________________________________ Social Security #____________________________________ Day Phone: AC ( ) - ( ) - ( )
	Quantity	Total
Refresher Manual $30.00 Refresher Test #1 $15.00 Refresher Test #2 $15.00 Helgin Manual Test #1 $15.00 Helgin Manual Test #2 $15.00 Helgin Manual Test #3 $15.00 Helgin Manual Test #4 $15.00 Helgin Manual Test #5 $15.00 Sub Total: Plus Shipping & Handling Total enclosed	x _____ x _____ x _____ x _____ x _____ x _____ x _____ x _____	$ _____.___ $ _____.___ $ _____.___ $ _____.___ $ _____.___ $ _____.___ $ _____.___ $ _____.___ $ _____.___ $ 7.50 $ _____.___
Send CEU Test Order and Fees to: ASPT P.O. Box 1831 Hickory, NC 28603 You may order and complete a test only once. Do not order the same test if you have completed it in previous years. NO REFUNDS ON MANUALS OR TESTS