Alpha-Omega Insurance Association Sign Up Form

ALPHA-OMEGA INSURANCE ASSOCIATION
Instructors - Scott Engell
407-331-5353 phone * fax 407-331-9149
E-Mail: ALPHAOMEGAIA@CFL.RR.COM
60-Hour Pre-Licensing Course
Life, Health & Variable Annuity

Location: 401 Center Pointe Circle, Suite # 1543 Altamonte Springs, FL 32701	Time: 7 A.M. – 5 P.M. Course Cost: $245.00 Study Manual: Included with the cost of course!
Mon, Tue, Wed, Thu, Fri, Mon, Tue Classes

Company Check, Cash, Money Order, MasterCard, or VISA

Make checks payable to:
Alpha-Omega Insurance Association
P.O. Box 162505
Altamonte Springs, FL 32716-2505

PLEASE PRINT

Name: Address:

Phone: _ City, St., zip ____

Social Security #________________ E-Mail _________________________

What class dates are you registering for?______________________________

Cancellations 7 days prior to class are refundable.

No shows are non-refundable but can be applied as credit toward future class registration within 3 months of original registration date.

www.alphaomegaia.com

Company Check, Cash, Money Order, MasterCard, or VISA

Name: ________________________ Address:________________________

Phone: ___________________­­­­____ City, St., zip ______________________

Cancellations 7 days prior to class are refundable.

Name: Address:

Phone: _ City, St., zip ____