DT1985 Wisconsin Aviation Mechanic Refresher and IA Renewal by I5bF59

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									                     WISCONSIN AVIATION MECHANIC REFRESHER AND IA RENEWAL
                                     ATTENDEE REGISTRATION
                                               Wisconsin Department of Transportation
                                                        DT1985 10/2010


To register for this seminar, please complete this form and mail with check. The following information is required for
registration.

 Last Name                                                         First Name


 Street Address


 City, State, ZIP Code


 Area Code – Telephone Number


 E-Mail Address


 A&P or IA Number



     Yes          No     I require a vegetarian meal.


 Registration Fees
 Seminar registration                                                                                      $30.00
 Late fee - see website for more information: http://www.dot.wi.gov/news/events/air/aviation-
                                                                                                           15.00
 mechanic-seminar.htm
                                                                                        TOTAL AMOUNT DUE


 Make check payable to:                Wisconsin Department of Transportation


 Mail this form with payment to:       Wisconsin Department of Transportation
                                       Bureau of Aeronautics
                                       PO Box 7914
                                       Madison, WI 53707-7914

								
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