BE CAREFUL! You need to enter your FIRST and LAST NAME here as you want them printed on your certificate. They need to be in ALL CAPS. If your browser auto-fills to anything but ALL CAPS - edit it! Remember if it's wrong here, it will be wrong on your certificate!
Use this nickname field for your name tag preference, if you have one.
** IMPORTANT - This email needs to be the INDIVIDUAL'S EMAIL - not a main company email. Class reminders and newsletters will go to this email address.
Type of Agent(*)
Will this registration be paid for by someone else other than registrant? If so, name of payee
Any Special Notes on this Registration?
When you click register you will be redirected to a page with links for payment options, you will also be sent an email with a copy of the answers on this form AND a copy of link to the payment options in case the landing page is lost. Check your junk folder if you do not see a copy arrive soon.