E-Mail Registration Form

(813) 253-7982


Registering for an OnLine Course is as easy as 1, 2, 3...

Please enter the requested information..

* Choose the course you wish to enroll in

* Enter the Course Reference number
Please enter the complete reference number. (Example: RMI-8234-73305.) NOTE: If "TBA" is shown, use date..


(CE) Life
  D.O.I. #40321
Course Ref Date
RMI-8235-01828 Open Registration

(CE) Health
    D.O.I. #40322
Course Ref Date
RMI-8234-01827 Open Reigstration

(CE) Ethics
  D.O.I. #53604
Course Ref Date
RMI-8279-01823 Open Registration

(CE) Flood
  D.O.I. #59082
Course Ref Date
RMI-8276-01824 Open Registration

(CE) Ethics & Client
  D.O.I. #(TBA)
Course Ref Date
RMI-8277-01825 Open Registration

(CE) Health Svg Acct
  D.O.I. #(TBA)
Course Ref Date
RMI-8278-01826 Open Registration

2-15
Life, Health and Annuities Pre-Licensing Completely Online Including Final Exam
course # 70952--- Provider # 0443
Course Ref Date
 RMI-8230-01889

Open Registration

 

2-15
Life, Health and Annuities PassPrep
Course Ref Date Time
RMI-8231-01829 Open Registration Completely Online

2-20
General Lines Insurance Completely Online Including Final Exam
course # 70950--- Provider # 0443
Course Ref Date
RMI-8060-01808 Open Registration

2-20
General Lines PassPrep
Course Ref Date Time
RMI-8232-01830 Open Registration Completely Online

Personal Lines Agent
Completely Online Including Final Exam
course # 70953--- Provider # 0443
Course Ref Date
RMI-8900-01810 Open Registration

4-40 Registered Customer Service Representative

course # INS005
Course Ref# Final Exam Date Day Time Campus Bldg.-Room#
RMI-8233-98221 2/27/10 Saturday 9AM-1PM Brandon (TBA)
RMI-8233-98337 4/24/10 Saturday 9AM-1PM Dale Mabry (TBA)
* Name (Last, First, Middle Initial)  
* Email or Fax #
*Retype your email address
* Home Phone
*Work Phone

* Permanent Address

Street
City
State Zip Code
*SSN# (123-45-6789) *Date of Birth (day / mo. / yr.) *Sex Male Female
* The following information is requested by the U.S. Office of Education
- Please Select One
White, Non-Hispanic Asian or Pacific Islander American Indian or Alaskan Native
Black, Non-Hispanic Hispanic
* The following information is required for some courses - Please Select One
I am a High school graduate. I am not a high school graduate.
*Residency Statement
I certify that I have resided in Florida as a permanent resident for the past twelve consecutive months or longer or otherwise meet the residency requirements outlined in the law of the State of Florida.
I have not resided in Florida as a permanent resident for the past twelve consecutive months and I do not meet the residency requirements.

*I declare under penalty of perjury punishable by law as a misdemeanor under Section 837.08, F. S., that the forgoing is true and accurate.
I do. I don't.
2. Fill out the Credit Card information below and Click Next
*
Don't Forget to fill out all of the Required Fields!
* Name as it appears on the credit card (IF DIFFERENT FROM STUDENT NAME)

* Credit Card Billing Address (IF DIFFERENT FROM STUDENT ADDRESS)

Street

City

State   Zip Code

* Credit Card type Visa  or Master Card 
* Credit Card Number Exp. Date
* Card Holder's Email Address or Fax #
(such as yourname@isp.com)
* Card Holder's Phone (xxx-xxx-xxxx)
* I certify that I am the card holder or have the card holder's permission to make this purchase.
I am the card holder I have permission

 Questions or Comments:

3. Click Submit -

Last Updated: February 8, 2010 by Melody Schiesl