I Pre-License Registration Form Please print legibly Name as it will appear on your future Real Estate License: ________________________________________________________________________ Name you go by: __________________________________________________________ Mailing Address: __________________________________________________________ City: ____________________________State: _______________Zip: ________________ Office Phone: ______________Home Phone: _____________Cellular: _______________ E-mail: ________________________________________ FAX #: ___________________ Social Security #: ___________________________ (required by state for our course completion records) Credit card #___________________________Exp:_________ Birthday month _________ Course Date and Information: Start Date Hour Price s Pre-License Module 1 45 Pre-License Module 2 45 Circle One: Day Night Weekend Total: Amount Enclosed: Refunds: No refunds within two weeks prior to the class start date. Classes and times are subject to change. (See website for the most up-to-date details.) How did you hear about us? _____ newspaper ______ internet _____ Recommended by_______________ MAIL YOUR CHECK WITH THIS COMPLETED APPLICATION FORM TO: Idaho Real Estate School * 3255 E. Overland Rd * Meridian, ID * 83642 CONTACT US: Nikki Sorini at: 208-685-6711 or by e-mail at info@Idahorealestateschool.com Disclaimer: Idaho Real Estate School is not responsible for ensuring that licensees have met and fulfilled continuing education requirements. Each individual licensee is responsible for tracking, accounting for and fulfilling individual continuing education requirements. Questions regarding continuing education courses and requirements should be directed to the Idaho Real Estate Commission, P.O. Box 83720, Boise, ID 83720-0077, 866-447-5411. The Course is made available to all qualified applicants, and the School will not discriminate on the basis of age, race, color, creed, religion, sex, handicap or national origin. If you have any special needs please contact the school administrator.
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