TI:ME ALTERNATIVE CERTIFICATION APPLICATION


Thank you for your interest in TI:ME Alternative Certification. 
Please print and complete this page and mail with payment to:


TI:ME
3300 Washtenaw Ave., Ste 220 
Ann Arbor  MI  48104



For additional information, please visit the TI:ME web site at:
http://www.ti-me.org/


PERSONAL INFORMATION

Name: ____________________________________________

Email Address: ___________________________________

Postal Address: __________________________________

__________________________________________________

City: _______________ State: _____ ZIP: __________

Country: _________________________________________

Phone: __________________ Fax: ___________________





SCHOOL/COMPANY INFORMATION

School/Company Name: _____________________________

Postal Address: __________________________________

__________________________________________________

City: _______________ State: _____ ZIP: __________

Country: _________________________________________

Phone: __________________ Fax: ___________________


PAYMENT

TI:ME 1A CERTIFICATION $150________
TI:ME 1B CERTIFICATION $150________


After your payment is received by TI:ME, you will be sent an email with a
username and password so you can download the course materials. The final
step in the process is to bring the completed files, materials and papers
to the TI:ME national conference. There will be sessions for TI:ME 1A and 
TI:ME 1B alternative certification at the Conference. Conference information
is available at the TI:ME web site (http://www.ti-me.org).

Please print and mail to:
3300 Washtenaw Ave., Ste 220 Ann Arbor MI 48104