Insurance Course Registration form
OnLine Training Institute:
2669 Forest Hill Blvd., Suite 207
West Palm Beach, Fl 33406-5953		 Voice: 561-357-0841
Fax: 561-357-4957
Toll Free: 866-357-0841		 Registrar: register@oltraining.com
Click here for Instructions
Click here for Policies
SECTION A
STUDENT NAME
EMAIL ADDRESS
SECTION B .....
MAILING ADDRESS
RESIDENCE TELEPHONE
CITY
 STATE
 ZIP
 BUSINESS TELEPHONE
SECTION C....
PAYMENT METHOD.     
Credit Card
Mailing a Check
Purchase Order / Invoice
CREDIT CARD NUMBER:     Exp. DATE:
AUTHORIZED SIGNATURE  (Type your name exactly as it appears on the Card)
SECTION D.....complete this section only if it is different from Section B
BILLING ADDRESS
CONTACT  PERSON
CITY
 STATE
 ZIP
 COMPANY
 BUSINESS TELEPHONE
SECTION E.....COURSE INFORMATION ( if more than one student is to be registered list their names and email addresses below)
 COURSE ID   COURSE TITLE PRICE NO. ORDERED
   INS001
Life and Health Cram Course (available in all states)
$49.95  
   INS002
Property and Casualty Cram Course (available in all states)
$89.95  
   INS003
Life and Health Pre-Licensing Course (Md, or Va only)
  $150.00  
   INS004 
Life and Health Tutorial (available in all states)
$89.95  
   INS008
Health Insurance Tutorial (available in all states)
 $59.95  
   INS009
Health Insurance Cram course (available in all states)

 $29.95

  
   INS010
Life Insurance Tutorial (available in all states)
 $59.95  
   INS011
Life Insurance Cram course (available in all states)

 $29.95

  

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Comments or Questions:
Once we receive your registration and process the charge you will receive your login and password for each course in which you are registered. Please print this page before you click Register OnLine [ Instructions ] [ Policies ]