Atlantic City Conference


STUDENT INFORMATION

First Name: Last Name:
Email Address: Date of Birth:
Home Address: City, State, Zip:
Home Phone #: Cell Phone #:
Insurance Lic #: License Exp. Date:


EMPLOYER INFORMATION

Business Name: Contact Person:
Address: City, State, Zip:
Phone: Fax:


CLASS INFORMATION

Course Date: Package:
Session: Credits:


PAYMENT INFORMATION

Credit Card #: Exp Date:
CVV2 Code: Billing Address:
Comments:
Match Letters on Right: USA    (This step prevents SPAM being sent to us)
I have read and accept the terms described HERE.  Initial to Agree: 
 


CONFERENCE INFORMATION
Dates: February 24 & 25, 2019
Hotel: Borgata Hotel Casino & Spa

 

Package Options

Package #1 
12 CE Credits
Meals (Breakfast & Lunch)
Sunday Night Room Included
$399.00

 

Package #2 

12 CE Credits
Meals (Breakfast & Lunch)
$299.00

 

Student Links

Check Your C.E. Credits
Enroll for the State Exam
Renew Your License
Contact the Dept. of Insurance
Forms & Documents

Corporate Information

Mailing Address
P.O. Box 579
Lakehurst, NJ 08733-9998
Phone: (732) 370 - 8111
Fax: (732) 370 - 8112

Atlantic School of Insurance

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