CMD Associate Application

	Certified Master Dealer® Associate Application**

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Total Training Package Cost - $2745

**Certificate of Participation Only
( See Eligibility Criteria )


* Please indicate the class that you would like to attend:		All classes will be held in Grapevine, TX. Located just 5 minutes north of the Dallas/Ft. Worth airport.
	November 20-23 , 2008

First Name,
MI, Last Name:

________________________________________________________________

Title / Position:

________________________________________________________________

Company Name:

________________________________________________________________

Mailing Address:

________________________________________________________________

City, State, Zip:

________________________________________________________________

Phone, Fax:

________________________________________________________________

Email, Website:

________________________________________________________________

Dealer License #:

________________________________________________________________

NIADA Membership #:

________________________________________________________________

Dealer's Approval Signature _________________________________________________________




There is a $125 processing fee that must accompany the application. This application fee is non-refundable regardless of approval.


METHOD OF PAYMENT: Enclosed is a check made payable to NIADA

Visa MasterCard American Express Discover
___________________________________________ Cardholder's Name ___________________________________________ Card Number	___________________________________________ Expiration Date ___________________________________________ Cardholder's Signature

For Office Use Only
Date Received	Approved

Please complete is application and submit to:

Georgia Brown, Director of Education
NIADA
2521 Brown Blvd.
Arlington, TX 76006
Fax: 817-649-5866