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* 1. Where should VALA send the refund?

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* 2. I am requesting a refund from VALA for the following IAAO class(es)

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* 3. Please enter the name of the individual that was registered to take this class.

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* 4. Amount of total payment made to VALA. (Total payment, not overpayment. Used for verifying that the payment was received.)

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* 5. Refund amount requested.

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* 6. Reason for refund. (select all that apply)

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* 7. Please attach proof of payment. (Not required, but helpful.)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 8. Date your payment was submitted. (If there is more than one payment date, please enter that information below in the "Please add any other helpful or pertinent information." section.)

Date

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* 9. Name and email address of individual filling out this form.

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* 10. I understand that this information will be reviewed and if it is discovered that I am due a refund, the refund will be issued by VALA in the form of a check and mailed to the address I have entered above.

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* 11. Please add any other helpful or pertinent information.

T