Contact us at wise.education@verizon.net © Wise Education, Inc. 2013-2019. All rights reserved.
WISE EDUCATION INC.
NJ, NY, & PA Continuing Education Specialists 1-800-577-9888
HORSHAM
Days Inn 245 Easton Road Horsham, PA 19044 215-674-2500 Days Inn Horsham
Check desired classes: __ 05/02/19 8am - 1 PERSONAL LINES ENDORSEMENTS (5 CREDITS) 5 CEC $79 __ 05/02/19 2pm - 5 ERRORS & OMISSIONS 3 CEC $59 __ 09/18/19 8am - 1 AGENCY ETHICS (5 CREDITS) 5 CEC $79 __ 09/18/19 2pm - 5 EXCESS & SURPLUS LINES 3 CEC $59 __ 12/11/19 8am - 12 FLOOD INSURANCE 4 CEC $69 __ 12/11/19 1pm - 4 EMPLOYMENT PRACTICES LIABILITY 3 CEC $59
PA Locations
To register by mail or fax for this location ONLY, follow these steps: 1. Print this page. 2. Check desired classes. 3. Fill in required information and send to: Wise Education, Inc. 1501 Cobblestone Ct. Thorofare, NJ 08086 Fax: 856-384-8414 Tuition Total $________ # of Credits______________ PAYMENT OPTIONS: ____Check #_________ Check amt. $__________ ____Visa ____MC ____Discover Expiration Date _____/______(Required) CC #_____________________________________ Cardholder Name____________________________ (Please print) Signature___________________________________ Comments:_________________________________ __________________________________________
FIRST_______________________MI____ LAST____________________________Jr / Sr / III DATE OF BIRTH _ _ / _ _ / _ _ PA LIC REF # _ _ _ _ _ _ _ -IP PA INS LIC EXP DATE _ _ / _ _ / _ _ HOME PHONE ( _ _ _ ) _ _ _ - _ _ _ _ MOBILE PHONE ( _ _ _ ) _ _ _ - _ _ _ _ HOME ADDRESS__________________________ CITY/ST______________________ZIP_________ BUS FIRM________________________________ BUS PHONE ( _ _ _ ) _ _ _ - _ _ _ _ BUS FAX ( _ _ _ ) _ _ _ - _ _ _ _ BUS ADDRESS___________________________ CITY/ST______________________ZIP_________ E-MAIL___________________________________ Please make a copy of this form and mark your calendar. No CE confirmations mailed. PLEASE ATTACH MEMO AS TO ANY SPECIAL NEEDS