CHARTERED BENEFIT CONSULTANT UPDATE CLASS

REGISTRATION FORM

TO NAABC:     Please send me the web address of the CBC Update course.  I have either enclosed a check or money order for the $100 tuition or want to use my credit card (see below) for payment.  I understand that I am to complete course and submit the quiz answers within two weeks of my receipt of the web address my CBC designation listing and my NAABC membership will be extended  an additional 24 months from the date of my current term’s expiration.  I further understand that, if NAABC does not receive my completed quiz within 15 days of the above receipt date, it will result in the loss of my listing in the national CBC Directory as of January 2008. 

Name: ___________________________________________                             Phone:  ____________________________

Address: _________________________________________                             Fax: _______________________________

                  _________________________________________          Email Address: ____________________________

PAYMENT OPTIONS

(CHECK APPROPRIATE  CHOICE)

Payment option 1: _____ Check or Money Order      PLEASE NOTE:  EVEN IF MAILING A CHECK OR  MONEY ORDER, PLEASE FAX THIS FORM  TO 630-858-2130.                      

Payment option 2: _____ Credit Card

I am registering with my CBC/NAABC membership renewal:  ____  (If you are paying by credit card, complete the credit card section below  ONLY if this registration does not accompany your renewal letter.)

Signature:  ______________________________________

If option # 2 is selected, please complete the following:

                                          Please circle card type:            AMEX    Visa    MasterCard

Card # ___ ___ ___ ___   ___ ___ ___ ___   ___ ___ ___ ___   ___ ___ ___ ___    Expiration date ___ ___ / ___ ___

Payment Amount:   _________________                          Signature ______________________________________  

Date________________          Printed Name as it appears on Card _______________________________________

You may either mail the completed form to the address below or fax to 630-858-2130

THANK YOU!

The National Association of

Alternative Benefit Consultants

435 Pennsylvania Avenue,  Glen Ellyn, IL 60137-4401

Toll Free: 800-627-0552   Fax: 630-858-2130  Email: NAABCX@aol.com