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 to receive course materials immediately: Pay online now by returning to the open ceresourcesinc.com window. For company pay simply list course selections below and type the name of your paying corporate sponsor. *
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