Student/Attendee Registration Form
Name
Your answer
Residential Address:
Your answer
Phone Number (Cell)
Your answer
Alternate Phone Number (Home, Work or Other)
Your answer
Personal Email
Your answer
Last 4 digits of social
This will be your examination and certification password
Your answer
Would you like us, CER Inc., to also complete your license renewal and send you a copy of your renewed license?
We process and upload everything to the state on your behalf. The $85 renewal fee for license renewal will be included in your invoice. (Please note effective 1-1-2016 the Alabama Department of Insurance license renewal fee increased by $30.00.)
CE Course Selection and Payment - (Please return to the open ceresourcesinc.com window)
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms