Requesting a Refund from VALA Question Title * 1. Where should VALA send the refund? Name * Company Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Email Address * Phone Number * Question Title * 2. I am requesting a refund from VALA for the following IAAO class(es) 101 112 155 158 Other Other (please specify) Question Title * 3. Please enter the name of the individual that was registered to take this class. Question Title * 4. Amount of total payment made to VALA. (Total payment, not overpayment. Used for verifying that the payment was received.) Question Title * 5. Refund amount requested. Question Title * 6. Reason for refund. (select all that apply) Overpayment. (i.e. individual should have paid as "VALA Member" or "IAAO Member") Paid for wrong class. Cancelled my registration within 21 days of class. Class was cancelled by VALA or IAAO. Other Other (please specify) Question Title * 7. Please attach proof of payment. (Not required, but helpful.) Attach a copy of your receipt from the online payment system or other proof of payment. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Attach a copy of your receipt from the online payment system or other proof of payment. Question Title * 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 / Time Date Question Title * 9. Name and email address of individual filling out this form. Name Email Address Question Title * 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. I understand Other (please specify) Question Title * 11. Please add any other helpful or pertinent information. Submit Request
