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New Jersey CENJ LocationsCourse DescriptionsCourse FeesRegistration Form
NEW JERSEY CE REGISTRATION FORM


To register for multiple locations, we request that you print this form below, fill it out, and send it to Wise Education Inc. by fax or mail. Thank you.
Wise Education, Inc.
1501 Cobblestone Ct.
Thorofare, NJ 08086
Fax: 856-384-8414
# of
classes
Tuition
# of
classes
Tuition
# of
classes
Tuition
# of
classes
Tuition
1
$70
5
$250
9
$450
13

CALL
FOR
PRICE
DISCOUNT
2
$110
6
$300
10
$500
14
3
$165
7
$350
11
$550
15
4
$220
8
$400
12
$600
16
Early Birds - Deduct 10% (postmarked 20 days prior to class)
DATE
CITY
TOPIC(S)
CIRCLE ONE
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___AM
___PM
___BOTH
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________________
_________________________________________
___AM
___PM
___BOTH
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________________
_________________________________________
___AM
___PM
___BOTH
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________________
_________________________________________
___AM
___PM
___BOTH
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________________
_________________________________________
___AM
___PM
___BOTH
Tuition Total $________  # of Credits_____________
PAYMENT OPTIONS:
____Check #_________ Check amt. $____________
____Visa    ____MC    ____Discover
Expiration Date _____/______(Required)
CC #_______________________________________

Cardholder Name_____________________________
                                                      (Please print)
Signature____________________________________

 Comments:__________________________________

____________________________________________
Wise Education of NJ 800-577-9888
wise.education@verizon.net

PLEASE ATTACH MEMO AS TO ANY SPECIAL NEEDS
FIRST_______________________MI____
LAST____________________________Jr / Sr / III
DATE OF BIRTH   _  _  / _  _ /  _  _
SOC. SEC. #   _  _  _  -  _  _  -  _  _  _  _
NJ LIC. # __________________________
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.

 

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