Ice Carver Certification Program (Page 2 of 4) in pdf

Ice Carver Certification Program Page 2

Carvers Info

Please fill out form completely and include all certificates, photos, photocopies and payment with

your application. Items will not be returned so please send copies.

NAME________________________________________________________________________________

ADDRESS____________________________________________________________________________

CITY______________________________STATE_______________ZIP___________________________

PHONE#(DAY)_____________________(EVENING)_________________________________________

DATE OF BIRTH___________________

EMPLOYER____________________________TITLE_________________________________________

# OF YEARS ICE CARVING EXPERIENCE_________________________________________________

Certification levels

Minimum Points

Application Fee

I Certified Ice Carver

$ 50.00

P Certified Professional Ice Carver

200

$ 75.00

M Certified Master Ice Carver

405

$ 100.00

I.C.E Certified Ice Carving Educator

N/A

$ 100.00

Payment Type: CHECK, MONEY ORDER ( ), VISA or MASTER CARD ( )

Credit Card # _____________________________________

Expiration Date ____________________

PLEASE MAKE ALL CHECKS PAYABLE TO N.I.C.A.

PAYABLE BY CHECK OR MONEY ORDER DRAWN ON A UNITED STATES BANK,

NO CASH PLEASE

FEDERAL TAX NUMBER 36-3703479

Please Mail your application with copies of all the required documentation to:

NICA

PO BOX 2314

Columbus, OH 43216

If you have any questions while completing your application, please call Jeff Petercsak @ (630) 871-8431.

Ice Carver Certification Program Page 2