Send Checks to : PIA of Hawaii, 146 Hekili St, Suite 201, Kailua, HI 96734

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