Remit Payment to : PIA of Hawaii, 1247 Kelewina Street, Kailua, HI 96734

Cost: $45 members, $55 non-members

1. Desired Course:
2. Name (Last, first):
3. Agency:
4. Business Phone:
5. Email Address:
6. License #:
7. Entity #:
8. PIA Member?: Yes
No
Mailing Address for Completion Certificate: