ICA Training Programs
On-Line Registration Form

I.T.A. Institute
P.O. Box 281
Grand Blanc,   MI   48480   USA

This On-Line Registration Form
is for those who wish to pay by CREDIT CARD.

Complete the form below and then click "Submit Application" at the bottom of this page.

When your Tuition fee has been paid in full and you have been admitted to the Program, you will receive the following:

      (1)   ICA DVDs for the Program you select.
      (2)   ICA Membership Card.
      (3)   The ICA Program Guide for your Program, outlining the requirements to complete the Program.

Testing Procedures

Once admitted to the program you are to submit video(s) in DVD format, of yourself performing the requirements for each Level you are testing for. You may submit promotion requirements using YouTube. Promotion Fees may be paid using a credit card. There are different Levels in each Program, so you shall be testing for each Level to complete the Program you are enrolled in. All Examination Fees must be in the form of a Money Order. Include the $45.00 Examination Fee (Foreign Countries $60.00 USD) each time you test. All fees are non-refundale and subject to change. Fees must be in U.S. Funds made payable to ITA Institute.
You are to Mail all examination materials to:

ITA Institute
Attn: Director of Admissions and Records
Post Office Box 281
Grand Blanc, Michigan 48480, U.S.A.

Acknowledgement of Terms and Conditions of Payment

I hereby apply for admission to the ICA Training Program I have selected below.
I fully understand that there are no refunds for any admission or tuition fees.
I certify that all information contained in this application and materials
submitted are true and accurate to the best of my knowledge
and by the submission of this application
I do hereby acknowledge and agree to the terms and conditions of payment.
I further certify that I am at least 18 years of age.

Please allow 4 to 6 weeks for processing.
(Payments are to be in U.S. Currency)

  ICA Headquarters    DVD Videos    Books

Credit Card Holder Information

Name (As it appears on Card):
Street Address:
Zip Code:
Phone: (Required
E-Mail Address (Required)

Credit Card Information

Card Number:
    Credit Card:     Exp. Date: Month       Year:

Select Your Program and Payment Amount

Application for Admission

First Name:
Middle Initial:
Last Name:
Street Address:
Zip Code:
Phone: (Required)
    Date of Birth (Month):
    Date of Birth (Day):
Date of Birth (Year):

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