Lake City E-mail Registration Form

ONLINE REGISTRATION FORM
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We gladly accept

For registration information, please call Sandy Root at (386)754-4300.

Notice: This online registration for Lake City Community College is processed through OnLine Training's secure server at CyberSource. Your student information is entered on this screen. On the next screen you may review your order. Following that, you may enter your Credit Card information and complete the transaction (within the secure server).

Course Information Select one or more courses by clicking the checkbox: (Required)
$84.00		14 hr CE Life
$84.00		14 hr CE Health
$28.00		3 hr CE Health Savings Accounts
$49.95		2-15 Life Health and Variable Annuity PassPrep
$24.95		2-15 Life Health and Variable Annuity Practice Exam
$89.00		2-15 Life Health and Variable Annuity Tutorial
$89.95		2-20 Property & Casualty PassPrep
$59.95		Real Estate Appraiser PassPrep
$89.95		Real Estate Salesperson PassPrep
$89.95		4-40 Registered Customer Service Representative PassPrep
$89.95		100 Hour Customer Service Representative PassPrep
$248.00		3-20, 5-20, or 6-20 Accredited Claims Adjuster

Student Information
(bold entries are required)

Student's Full Name:	*(Required)*
E-mail Address:	*(Required)*
Social Security Number:	*(Required)*
Date of Birth (day/mo/yr):	*(Required)*
Mailing Address:
Street:	*(Required)*
City:	*(Required)*
State:	Zip code: *(Both Required)*
Contact Phone, with Area Code:	*(Required)*
Alternate Phone, with Area Code:

Other
(bold entries are required)

Sex: Male Female *(Required)*
The following information is requested by the U.S. Office of Education - please select one: (Required)
	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: (Required)
	I am a high school graduate. I am not a high school graduate.
Residency Statement: (Required)
	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 requirments.
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. (Required)

Refund Policy - Refund must be requested in writing by email to Sandy Root roots@lakecitycc.edu within 72 hours of the time date stamp on the Welcome Message sent out from OnLine Training Institute. Welcome Messages are usually sent out within 1-2 business days of emailed registration. Non-Attendance at In Class Final does not constitute an acceptable reason for refund.