Page 4 - MIADA-Q4 2023

Mississippi’s Used Auto Dealer Pre-licensing Seminar

Required by the Department of Revenue

SEMINAR LOCATION
MSIADA Office: 1705-A Old Whitfield Road, Pearl, MS 39208
Office (601) 939 – 9866 Fax (601) 939 – 9882

SEMINAR DATES
❑ Jan. 20, 2024/ 9a.m.-2p.m ❑ Feb. 17, 2024/ 9a.m.-2p.m ❑ Mar. 23, 2024/ 9a.m.-2p.m
❑ Apr. 20, 2024/ 9a.m.-2p.m ❑ May 18, 2024/ 9a.m.-2p.m ❑ Jun 22, 2024/ 9a.m.-2p.m
❑ July 20, 2024/ 9a.m.-2p.m ❑ Aug 17, 2024/ 9a.m.-2p.m ❑ Sept. 21, 2024/ 9a.m.-2p.m
❑ Oct. 19, 2024/ 9a.m.-2p.m ❑ Nov. 16, 2024/ 9a.m.-2p.m ❑ Dec. 14, 2024/ 9a.m.-2p.m

Registration Fee: $395.00 Please submit registrations with payment to MSIADA at least seven days prior to the date of the seminar you
plan to attend. Fee includes online portion of the seminar. You must complete the online portion prior to class day. Your seat will be
reserved, and certificates will be received at the end of the seminar. Registration Fee does not include MSIADA membership, required if
you want MSIADA to assist in completing Dealer Application and consult on your behalf.

Late Registration Fee: $50.00 Late registrations will be accepted the week before class. Walk-ins are NOT accepted on the morning of
class. On the day of the seminar. No checks will be accepted.

Transfer Fee: $50.00 If you wish to transfer your registration to another scheduled seminar date, a 72-hour notice is required, and a
transfer fee is applied.

Cancelation Fee: $50.00 All cancelations are to be made 72 hours in advance to receive a refund, minus the cancelation fee.

Note: Due to limited and reserved seating, we cannot allow anyone to sit-in.
_______________________________________________________________________________________________________________________

PRE-LICENSING REGISTRATION FORM

Full Name as you would like it to appear on certificate: _____________________________________________________________
Physical Address ___________________________________________________________________________________________________
City ____________________________________________________________________State __________________Zip ________________

Phone ____________________________________________________ Fax __________________________________________________
Email Address _____________________________________________________________________________________________________
Business Name ____________________________________________________________________________________________________

Physical Address___________________________________________________________________________________________________
City ____________________________________________________________________State __________________Zip _______________

Phone ___________________________________________________ Fax _________________________________________________
Email Address ____________________________________________________________________________________________________

Payment Method: ❑Check Enclosed ❑Money Order ❑VISA ❑MC ❑DISC ❑AMEX

Account # _________________________________________________________________________ Exp _______________________

Account Name_____________________________________________________________________ Zip ________________________

Registration Fee $________________________ + C/C Proc. Fee $3.50 = Transaction Total $_______________________________

Signature of Authorization __________________________________________________________________________________________