PLEASE COMPLETE THIS FORM FOR PRE-LICENSE OR CONTINUING EDUCATION REGISTRATION. PRE-REGISTRATION AND PRE-PAYMENT IS REQUIRED. WE ACCEPT VISA, MASTERCARD AND AMERICAN EXPRESS CREDIT CARDS. THIS FORM UPDATED 2/20/08 FOR YOUR EASE OF USE.
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NAME: |
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STREET ADDRESS: |
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CITY/STATE/ZIP CODE: |
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| EMAIL ADDRESS: |
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| PHONE NUMBER: |
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METHOD OF PAYMENT PLEASE CHOOSE ONE |
CHECK by MAIL CREDIT CARD VISA MASTERCARDAMERICAN EXPRESS |
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CREDIT CARD NUMBER: |
PLEASE SEPARATE THE GROUPS BY DASHES(-) (XXXX-XXXX-XXXX-XXXX) |
| CARD EXPIRATION DATE: |
(MM/YY) |
| NAME ON CREDIT CARD: |
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| AMOUNT TO CHARGE: |
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| TYPE OF PAYMENT: |
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PLEASE MAKE YOUR REGISTRATION SELECTION FROM ONE OF THE FOUR CATEGORIES BELOW. |
REVIEW THE ENROLLMENT AGREEMENT FOR PRE-LICENSING CLASSES. |
HOME INSPECTION PRE-LICENSING CLASSES |
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DAY PRE-LICENSE CLASS DAY CLASSES 8AM-5PM M-F 8AM-5PM M-W |
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EVENING PRE-LICENSE CLASS TUESDAY & THURSDAY EVENING 6-10PM PLUS ONE SATURDAY:
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RADON PRE-LICENSING: M-T 8AM-5PM W 9-11AM TEST |
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HOME INSPECTOR CONTINUING EDUCATION : |
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| CONTINUING EDUCATION PROGRAMS: |
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PLEASE TYPE IN ANY MESSAGE OR INQUIRY. WE APPRECIATE HEARING FROM YOU!: |
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You will be returned to the Home Page after clicking Submit Button. |
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