American Snowsport Education Association Central

3225 West St. Joseph, Lansing, MI 48917 (517) 327-0601 PH (517) 321-0495 FAX

Education Waiver Request Form

Four waivers are granted to a member during the lifetime of their membership in ASEA C.
Waivers are requested when a person is still teaching during the season, but cannot fulfill their
education requirements. Waivers cannot be requested for past seasons. The fees for waivers are as
follows:
1st Waiver Free
2nd Waiver $50.00
3rd & 4th Waiver $100.00

Please fill out the following information and return to the ASEA- C office along with your
payment. Thank you.

NAME OF ASEA-C MEMBER ________________________________________________________________

NATIONAL ID # ______________________ WAIVER #: _______________________________

ADDRESS ________________________________________________________________________________

CITY __________________________________________ STATE ________________ ZIP _______________

PHONE ____________________________________ EMAIL __________________________________

PAYMENT INFORMATION

PAYMENT TYPE: NONE FIRST WAIVER CHECK ENCLOSED CREDIT CARD

CREDIT CARD: MASTERCARD VISA EXP.

CC#: ____________________________________________

SIGNATURE: ____________________________________ DATE: ____________________________