Continuing Education Seminars of North Carolina

Registration Form
All Classes  are rated "B" on the NCDOI rating scale
Name:      Last      First    MI
Home Address  
City, State, Zip  ,         (xxxxx-xxxx)

Company  Name  
Business Address   
  City, State, Zip     ,         (xxxxx-xxxx)    

          Business Phone    Fax     Home Phone

           Date Attending      Location:  707 Coliseum Plaza Court              (xxx xxxxxxx)

Beginning January 1, 2010, the NCDOI and Prometric will require the National Producer Number (NPN) instead of the last 5 digits of the SS number.  It is up to the licensee to obtain their number and put it on the CE application in order to get credit.

           Today's Date       Last 5 digits of SS#      NPN # 

              CE Course #           Amount Enclosed    

               SEND    Click here to e-mail Registration Form to Robert Weatherman

              Link to  Seminar Schedule

          $55.00 per 3-hour credit course         $100.00 per 6-hour credit course

 $15.00  Additional for Walk-in Registration

Fill out Registration Form   (OR Print out this Form and Fill out by Hand)
   Print Out this Form  (Select File, Print from your Browser)
Mail Completed Form and Check OR Money Order   Payable to: 

Robert M. Weatherman,  P.O. Box 166,  Winston-Salem, NC   27102

Phone:  (336) 777-0099   Fax:  (336) 777-0122

No confirmation will be sent. You will be notified ONLY if a class is cancelled.