Certified Insurance Service Representatives (CISR)
Registration Form

Fields in Yellow are Required

YOUR INFORMATION

           












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CLASS REGISTRATION
This is my first CISR class        This is my annual CISR designation update
I am working towards CISR Elite Designation.

To register for a class, click the checkbox next to the Course Title and then select the Class Date and City

Course Title: Class Date and City:




Registration Fee is $175.00 per Class
Cancellation Policy: Cancellations received more than 10 days prior to the start of the program are subject to a $50 administrative fee. No-shows and cancellations within 10 days of the class will result in forfeiture of the entire registration fee. Transfers may be made up to two days prior to the class date for a $50 administrative fee. Participant substitutes are honored anytime without penalty.


PAYMENT INFORMATION
Payment Information: Payment is due prior to the class — late payments will be assessed a $25 fee.
Method of Payment:   
Visa     MasterCard     American Express     Check
A 3% Processing Fee Will Be Charged To All Credit Card Transactions.
Registration Fee for Classes Selected Above: $0.00
By checking this box and submitting this form, you authorize and commit to the payment of $0.00 for CISR class registration, per the cancellation policy described above.