Institute of International  Container Lessors
. . . . . . the trade association for the container and chassis leasing industry since 1971. . . . . .


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IICL
1990 M Street NW
Suite 650
Washington, D.C. 20036-3417
info@iicl.org
Telephone:  1-202-223-9800
Fax: 1-202-223-9810
2008 CHASSIS EXAM REGISTRATION FORM

COMPLETE Questions #1-15
DO NOT DISTRIBUTE THIS FORM WITHOUT THE 2008
CHASSIS INSPECTOR’S TEST INFORMATION BULLETIN
Type or print legibly.EXAMINATION DATE: Saturday,  September  27,  2008
Complete questions 1-15 below.
Note: Fields with (*) are mandatory.

1. NAME : *
Surname/Family Name First/Given Name Middle Initial
2. HOME ADDRESS : *
CITY : *       STATE :
POSTAL(ZIP) CODE : *       COUNTRY : *  
3. YOUR E-MAIL : *      

      TELEPHONE : * --
Country codeCity/Area code      Telephone number
                     Note: For U.S and Canada and U.S Territories the country code is 1.
                     FAX :   
4. NATIVE LANGUAGE :(Language Spoken at Home)     
5. COMPLETE (A), (B), or (C) BELOW. If you pass the examination, your name will be listed in the IICL Inspection Directory. Specify how you want to be listed: If you do not make a selection, IICL will choose (A) if you do not have a company or (B) if you have a company.
A. Do you wish to include your Name and your Home Address?
YesNo
B. Do you wish to include your Name and your Company Name/Address?
YesNo
C. Do you wish to include your Name, your Company Name and your Home Address?
YesNo
6. Where you want to receive IICL correspondence including Registration Confirmations, Admission Letters, and Score Reports:Home AddressCompany Address
7. TEST CENTER CITY/STATE : *        TEST CENTER CODE :
8. COMPANY NAME :
COMPANY ADDRESS :
 
CITY :      STATE :
POSTAL(ZIP) CODE :       COUNTRY :
9. MAIN CO. TELEPHONE : - -
Country codeCity/Area code      Telephone number
   Note: For U.S and Canada and U.S Territories the country code is 1.
MAIN CO. FAX :    
MAIN CO. EMAIL :     COMPANY WEBSITE :
10. TYPE OF EMPLOYER
(COMPANY) :		 1. Leasing Company
2. Ship Line
3. Depot/Repair Company
4. Surveying Company
5. Other (specify)    
11. YEARS OF EXPERIENCE IN CHASSIS INSPECTION/REPAIR
  1. Less than 1  4. 7 - 9 years
  2. 1 - 3 years  5. 10 - 13 years
  3. 4 - 6 years   6. 14 or more
12. IF PREVI0USLY CERTIFIED BY IICL, LIST YEAR(S) :      
(example 1992 and 1997)
13. Submission of Photo Image to be used for Photo ID card.
Upload Digital Image:   
Note: Please upload the file in jpeg format and save the file as your first and last name. Example: Your name: John Smith. Save file as: johnsmith.jpeg. You can also mail your photograph to us. Size should be 140x180 pixels approx.(passport size) or send us a floppy disc with your digital photo saved on it.
14. AFFIRMATION: By signing and submitting this registration form, I accept the conditions set forth in the 2008 Chassis Inspector’s Certification Examination “Test Information Bulletin” concerning the administration of the test on September  27,  2008, the reporting of scores, and the certification policies.
Type your name EXACTLY as you wish it to appear on your certificate : *
EARLY FEE: US$225.00
EARLY REGISTRATION DATES/DEADLINE
Until May  25,  2008		REGULAR FEE: US$250.00
REGULAR REGISTRATION DATES/DEADLINE
May  26,  2008 – August  10,  2008		LATE FEE: US$275.00
LATE REGISTRATION DATES/DEADLINE
August  11,  2008 – August  31,  2008
15. PAYMENT OF REGISTRATION FEE :
In case of payment made by Check, MoneyOrder, TeleTransfer, please enter the payment details and mail (optional) this filled in form along with your Check/ MoneyOrder/ TeleTransfer to the address or Fax it to the number mentioned below.
CheckCHECKS MUST BE EXPRESSED IN U.S. DOLLARS (USD) & DRAWN ON A U.S. BANK.  Complete the registration form, enclose check or money order and mail to IICL
Money OrderINTERNATIONAL MONEY ORDERS MUST BE EXPRESSED IN U.S. DOLLARS (USD).  Complete the registration form, enclose check or money order and mail to IICL
TeletransferComplete the registration form, indicate the date of your teletransfer, and fax to IICL. Include $25 for each teletransfer (1 candidate: registration fee +$25.00; 2 or more candidates: registration fees +$25.00)
Teletransfer Instructions : Send funds c/o Citibank, N.A. BR. #83, Bedford, NY, Institute of International Container Lessors (IICL), IICL Account No. 9965467345, ABA/bank "transit" number: 021000089. SWIFT CODE: CITIUS33  INCLUDE Citibank’s $25.00 service charge in your teletransfer amount. Also include YOUR COMPANY NAME and NAME OF TEST CANDIDATE.
ENTER AMOUNT($) : *
ENTER PAYMENT METHOD : *
  CREDIT CARD

Type:  
Card No:  
Card Expiry Date :  Month    /  Year  
  Check

Details :  
  Money Order

Details :  
  TeleTransfer

Details :  
REGISTRATION CONFIRMATIONS will be sent to you as soon as possible after IICL receives your registration form AND payment.  Registration Confirmations contain important information that you should read carefully and retain until the examination.
THERE ARE 4 WAYS TO REGISTER:
  1. Register Online at http://www.iicl.org/ChassisInspectorsTestInfo.htm
  2. MAIL YOUR REGISTRATION FORM & PAYMENT TO IICL: IICL, 1990 M Street NW, Suite 650, Washington, DC 20036-3417 USA
  3. COURIER YOUR REGISTRATION FORM & PAYMENT TO IICL: IICL, 1990 M Street NW, Suite 650, Washington, DC 20036-3417 USA
  4. FAX YOUR REGISTRATION FORM WITH CREDIT CARD OR TELETRANSFER INFORMATION TO 1-202-223-9810
MARK THE EXAMINATION DATE ON YOUR CALENDAR: Saturday,  September  27,  2008
CONTACT IICL IF YOU DO NOT RECEIVE A CHASSIS TEST ADMISSION LETTER BY   September  17,  2008



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