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PLEASE READ & PRINT OUT Summit Schools, Inc. Mail to: |
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| Pre-licensing Courses Registration Form | Summit
Schools, Inc
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| BACK | |||||||||
| •If you wish to pay with a credit card, you must register over the phone. 1-800-432-6406 | |||||||||
| •Please read Cancellation and refund policy in the School Catalog. | |||||||||
| •Please call us if you are mailing form and payment less than 12 days before the class begins. | |||||||||
| •Payment for class must accompany the registration form. Call if you need help. | |||||||||
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•We are NOT
responsible for lost mail or checks. If you do not receive confirmation in
reasonable time after mailing your form with check, call our office at 1-800-432-6406 |
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•You will
receive a confirmation letter and school information via e-mail as soon as this office
receives your payment with registration form. |
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| •You will receive your books on the 1st day of class. | |||||||||
| Date___________ and Location _________________of class you are signing up for: | |||||||||
| CLASS SELECTION (includes Law & Ethics & books) | |||||||||
| q Life & Accident/Health | $ 275.00 + book tax | 8 am-5 pm all 4 scheduled days | |||||||
| q Life Only | $ 250.00 + book tax | 8-5 day 1 & 2, 8 - noon day 3 | |||||||
| q Accident Health Only | $ 250.00 + book tax | 1 pm-5pm day 2, 8-5 day 3 & 4 | |||||||
| q Property & Casualty | $ 275.00 + book tax | 8 am-5 pm all 4 scheduled days | |||||||
| book sales tax = Appleton +$ 1.55 ( 5.0 %) – Madison & Menomonie +$1.71 (5.5% ) | |||||||||
| ***If you have the newest edition Pathfinder, Intermediary Guide and Ethics Manual, subtract $ 33.00*** | |||||||||
Student Legal Name __________________________________________ |
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| Birth date (ex: 02/16/1974) ___ ___ / ___ ___ / ___ ___ ___ ___ | |||||||||
| Last 4 numbers of Social Security # ___ ___ ___ ___ | |||||||||
| Home address | |||||||||
| City,State & Zip | |||||||||
| Home/cell phone # | |||||||||
| E-Mail Address for confirmation (NO Yahoo, please use alternate): | |||||||||
| Company Name you will be working for: | |||||||||
| Mailing address | |||||||||
| City, State & Zip | |||||||||
| Business phone # | |||||||||
| Business FAX # | |||||||||
| AMOUNT ENCLOSED $ | |||||||||