CIPA PROGRAM PAYMENT OPTION(S)

FORM

PAYMENT OPTION(S) FORM

CANDIDATE REGISTRATION NUMBER (CRN) __________________________________________________

(leave empty if you do not have it)

CANDIDATE NAME __________________________________________________

There are three payment options available: Full payment or payment in either 2 or 4 installments. The

amount payable, in US Dollars, for each option is mentioned as follows. You are required to circle the

payment option/amount which you intend to make in order to register for the CIPA Program.

Currency: USD Full Payment Payment in 4 Installments Payment in 2 Installments

1st 2nd

3rd 4th 1st 2nd

No Discount

Total Fee Payable by Candidate 2200 550 550 550 550 1100 1100

After 10% Discount

Total Fee Payable by Candidate 1980 495 495 495 495 990 990

After 20% Discount

Total Fee Payable by Candidate 1760 440 440 440 440 880 880

Payment Option Description Fee Components are:

Full Payment Option

You pay once and in full to register for the

complete CIPA Program

1) Program Registration Fee; 2) 4 Study Texts; 3) Shipment Costs; 4) 4 Mock Exams; 5) 4 Exam Sittings (one sitting per module); 6) PER Fees; 7) CIPA Certificate Fee

4 Installment Option

You pay in four installments: each

installment registers you for one module

of your choosing

First installment includes: 1) Program Registration Fee; 2) 4 Study Texts; 3) Shipment Costs; 4) 1 Mock Exam; 5) 1 Exam Sitting; 6) PER Fees; 7) CIPA Certificate Fees Second, Third, and Fourth installment includes: 1) 1 Mock Exam and 2) 1 Exam Sitting per module for 3 modules

2 Installment Option

You pay in two installments: each

installment registers you for two modules

of your choosing

First installment includes: 1) Program Registration Fee; 2) 4 Study Texts; 3) Shipment Costs; 4) 2 Mock Exams; 5) 2 Exam Sitting2; 6) PER Fees; 7) CIPA Certificate Fees Second Installment includes: 1) 1 Mock Exam and 2) 1 Exam Sitting per module for 2 modules

I fully understand the payment options plan and agree to pay all Fees applicable in full and on time to the best of my ability.

CIPA PROGRAM PAYMENT OPTION(S)

FORM

CANDIDATE SIGNATURE: ____________________________________ DATE: _____________________