June 26-27, 2017 Initial Bus Registration - Manito Day 1(26th) -11:30 to 3:30, Day 2 (27th) 8:00 a.m. to 12:00 p.m.
Data will not be entered into the state system until course completion AND cash, check or money order payment is received by ROE #53, 414 Court St. Suite 100, Pekin, IL 61554
Last Name *
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First Name *
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Middle Name *
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Email Address *
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Primary Phone Number *
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Home Address *
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IL Driver's License Number *
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Employer Name *
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Employer Address *
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Date of Hire (mm/dd/yy) *
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