Real Estate Continuing Education Registration

Please complete all fields. (Fields with a red asterisk must be completed.)
To register online, you must use a Visa or MasterCard.

Name:	*
Real Estate License Number:	*
License Expiration Date:	*
Email:	*
Address:	*
City:	*
State:	*
Zip:	*
Day Phone:	*
Evening Phone:
Fax:
I wish to make payment by Visa or MasterCard ONLY:
Credit Card Number:	*
Expiration Date:	*
Name on card if different:
Course Date:
Course Number:	1 2 3 4 5 6 *
Course Date:
Course Number:	1 2 3 4 5 6
Total number of class hours to be taken:	*

Comments:

Refunds, less a $15.00 enrollment fee, can be made by a request in writing 7 days prior to the seminar date. Reschedule, in writing, one time free. Thereafter, a $15 administrative fee will be charged. You may reschedule without penalty for cancellations due to inclement weather or lack of enrollment. Dress comfortably; bring a sweater. Please arrive on time. You will not be admitted once class has begun.

Email us if you have any questions: realinst@aol.com

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