Certified Professional Insurance Agent (CPIA)
Registration Form

Blue fields are Required
YOUR INFORMATION

           












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CLASS REGISTRATION
PIA Member ($170.00 per class)        Non-PIA Member ($190.00 per class)
This is my first CPIA class            This is my CPIA designation update

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:




NEW CANCELLATION POLICY FOR 2023 — Cancellations received within 3 days of the class will incur a $25.00 non-transferable fee. No-shows will forefit the entire registration fee.


PAYMENT INFORMATION
Registration Fee for Classes Selected Above: $0.00
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.
By checking this box and submitting this form, you authorize and commit to the payment of $0.00 for CPIA class registration, per the cancellation policy described above.