If you currently hold more than five designations, please put them in the comments field. Putting in designations will ensure that you get notified of important courses such as the James K. Ruble Seminar or the William T. Hold Seminar.
Designations:currently held
*First Name:
Middle Intial:
Middle Initial is highly recommended to keep your records correct.
*Last Name:
Badge Name:
*Birthdate: (mm/dd/yyyy)
*Company Name:
*Company Mailing Address:
*City:
*State:
*Zip Code:
*Phone Number: (000) 000-0000
FAX Number: (000) 000-0000
* Email:
First Time Attending
Continuing - and do not have designation
Last class I need for designation
Serve as an Update for designation
Email my confirmation letter & class agenda to me - (must supply valid email address to receive information)
Mail my confirmation letter & class agenda to me
State License Number:
Comments:
Cancellation Policy:
You must read the following cancellation policy. CISR cancellations received within 10 days of the course will incur a $50 non-transferable fee. There will be no refund if participant is a "no-show". CIC cancellations received within 3-10 days of the institute will incur a $50 non-transferable fee. Cancellations received within 1-2 days of the institute will incur a $150.00 non-transferable fee. There will be no refund if participant is a "No-show".
* By clicking on the check box, you understand and agree to the cancellation policy stated above.
Please enter the text in the picture. The letters are case sensitive and should be entered as capitals.
* Required Fields
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