Central Region CE Registration – Dec 2022

• Name*
  First Last
• Address*
  Mailing Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Cell Phone*
• Email*
• Illinois License #*
• Wisconsin License #
• District #
• LOCATION: Springfield, IL*
  Springfield, IL - Dec 15 & 16, 2022
  Ramada Springfield North 3281 Northfield Drive Springfield, IL 62702
• CE Classes*
  Illinois OnlyWisconsin & Illinois (I understand I will be billed for Wisconsin Classes by ISAA - $25 per class)
• Ethics (12/15/22)*
  NOT AttendingReal Estate Contracts - $40.00
  Mandatory Course
• Conducting Benefit Auctions (12/15/22)*
  NOT AttendingBenefit Auctions - $40.00
  Elective Course
• Social Media (12/15/22)*
  NOT AttendingSocial Media - $40.00
  Elective Course
• Sexual Harassment Prevention (12/16/22)*
  NOT AttendingSexual Harassment - $40.00
  Mandatory Course required by IDFPR as of 2020.
• Credit Card Processing Fee
  Price: $0.00
  5% Credit Card Processing Fee
• Total
  $0.00
• Credit Card
  Card Details

  Cardholder Name

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