2012 CONTINUING EDUCATION COURSE REGISTRATION FORM

 

(Real Estate Brokers & Salespersons for 2012 license renewal)

 

NAME __________________________________________________________________________________________________________________________

 

ADDRESS _______________________________________________________________________________________________________________________

(Street)                                                                               (Town)                                                                          (State)                                        (Zip)

 

TELEPHONE:  Office: _____________________  Residential:  _____________________  Fax:  _____________________  Cell:  _______________________

 

E-mail Address:  ________________________________________________

 

 

COURSE LOCATIONS AND DATES      ________________________________________________________________________________________________

Course Number                                                          Location                                                                       Date

 

________________________________________________________________________________________________

Course Number                                                          Location                                                                       Date

 

METHOD OF PAYMENT     (      ) Check          Payable to:  DON PAUL SHEARER INC.                      Total Amount  $_______________________

                                         

(     ) Visa    (     ) MasterCard                   Card Number_________________________________________________________

 

Signature ______________________________________________________________  Exp Date ________________

 

TO REGISTER         Fax This Registration form to us at (717) 731-1191 or mail to P.O. Box 717, Camp Hill, PA 17001-0717,

E-mail to us at don@dps-pa.com, or Call us at (717) 731-8800 or (800) 392-8700.

 

TUITION                     Course Booklets are included in the tuition.

 

                                     1 Course                                 $80.00

                                     2 Courses + USPAP             $150.00 (pre-paid)

 

EDUCATION DIVISION OF DON PAUL SHEARER INC.

A STATE APPROVED PRIVATE REAL ESTATE SCHOOL

Founded in 1976

dps