AFIE COURSE REGISTRATION FORM CERTIFIED DEALERSHIP FINANCIAL SERVICES MANAGEMENT PROGRAM If you are human, leave this field blank. Full Name * Address * City * Province * Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavit Ontario Prince Edward Island Quebec Saskatchewan Yukon Select Your Course Date * September 23-27 Langley B.C. Finance Manager Progressive Program October 28 - November 1 Finance Manager Progressive Program November 25 - 29 Finance Manager Progressive Program Select Your Training Level AFIE Essentials AFIE Select AFIE Select Plus Postal Code * Phone Number * Email Address * BirthDate MM/DD/YYYY * Driver's License Number VSA Number or Current Employer Payment Method * Visa Mastercard Name as printed on Card * Number on Card * Expiry Date * Card Security Code (on the back of the card) * *PLEASE REGISTER AS EARLY AS POSSIBLE AS SPACE IS LIMITED. NON-REFUNDABLE COURSE FEE. *FOR FURTHER QUESTIONS PLEASE EMAIL: firstname.lastname@example.org.