Maryland & D.C. Approved Pre-Licensing Training
Registration for A+ Insurance Training
Select one: I will be taking the Maryland exam
I will be taking the D.C. exam
STUDENT INFORMATION
Student's Name
Class date(s) attending
Mailing Address
City State Zip
Work Phone Home Phone Cell
E-mail address
COMPANY INFORMATION
Company or agency name
Mailing Address
City State Zip
Manager's name
Manager's phone
Manager's e-mail address
TUITION & FEES
Standard Tuition (choose one)
1-day class $150
2-day class $200
2-day plus $280
I'm registering and paying more than 10 days
before class for discounted rate, subtract $15
Yes No
I'm paying more than 10 days before class and
want books shipped to me in advance, add $15
Yes No
OPTIONAL: For a CD-ROM with hundreds of practice questions
for more self-study, please add $40.00.
Ship books to home address business address
Else, books will be provided at the first class
Total tuition & fees:
If you have a referral code, enter it here:
PAYMENT
Payment Information: Make checks payable to A+ Life & Health Training
I am bringing a check to the first class
I am mailing a check
I am paying now via PayPal
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(Send your Paypal payment to LandHtraining@comcast.net)
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(Send your Paypal payment to LandHtraining@comcast.net)
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Alternative: Mail or fax registration to:
A+ Life and Health Training
9612 Jester Court, Laurel, Maryland 20723
Fax: 301-725-6019
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