Idaho Real Estate Commission by eba19447

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									                                  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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