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
MOUNT AIRY
Mount Airy Resort Casino 44 Woodland Road Mount Pocono, PA 18344 877-682-4791 www.mtairycasino.com
There will be no classes held at Mount Airy 2016. Please consider joining us at either our Myrtle Beach getaway or our Atlantic City Blitz.
NJ Locations
PA Locations
To register for multiple locations: Go to registration form 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 _ _ / _ _ / _ _ NJ LIC REF # _ _ _ _ _ _ _ -IP NJ 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
I wish to earn CE credits for the following state(s):
State ___ Lic #______________ Exp _________
State ___ Lic #______________ Exp _________
State ___ Lic #______________ Exp _________