Registration Form -- PRINT AND FAX THIS PAGE TO ISC at 312-427-8528.

Use this form to register for classes, seminars, pre-licensing, or home-study courses.
Use the Book Order Form to purchase books.
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THE INSURANCE SCHOOL OF CHICAGO, 330 S. Wells - #300, Chicago, IL  60606, Ph: (312) 427-2520, Fax: (312) 427-8528

Last Name
First Name and Middle Initial
Social Security No. (Must Have to Register)
Apt/Floor
Home Address
City
State
Zip
Home Phone
Home e-mail
Employer
Dept/Suite Number
Work Address
City
State
Zip
Work Phone
Work e-mail
Work Fax
Position/Title

LIST THE CLASSES OR SEMINARS FOR WHICH YOU ARE REGISTERING (NOTE:  To order class textbooks, go back to the home page, click "Book Order Form," and print out and complete that form):

ITEM 1 is   Name
Section/Course No.   Location (if applicable)
Date (if applicable)    Fee $
ITEM 2 is   Name
Section/Course No.   Location, if applicable
Date, if applicable    Fee $
ITEM 3 is   Name
Section/Course No.   Location, if applicable
Date, if applicable of    Fee $
ITEM 4 is   Name
Section/Course No.   Location, if applicable
Date, if applicable    Fee $
ITEM 5 is   Name
Section/Course No.   Location, if applicable
Date, if applicable    Fee $
ITEM 6 is   Name
Section/Course No.   Location, if applicable
Date, if applicable    Fee $
YOUR COMMENTS:

Shipping & Handling FOR HOME STUDY MATERIALS ONLY

One Package $8.00
2-3 Packages $9.00
4-5 Packages $10.00
6+ Packages - Call ISC 312-427-2520

AMOUNT DUE

ITEM 1
ITEM 2
ITEM 3
ITEM 4
ITEM 5
ITEM 6
          Sub Total (Items 1-6)
SHIPPING CHARGES
        Total Amount Due

PAYMENT METHOD

Make Checks Payable to:  The Insurance School of Chicago

My check is enclosed:  $.  (This option is for  those mailing this registration form.  Just print the form and complete it, enclose your check, and mail it to the address above.)

Please charge my Visa or MasterCard.  (This option is for faxing or mailing this registration form.)
PLEASE NOTE:  ISC cannot accept American Express, Diners Club, or Discover card payment.

Your Visa or MasterCard #: Expiration Date:

Signature: (required if faxing or mailing form)

Card Billing Address:________________________________________________________

3-Digit Security Code from back of credit card____________ Billing Address Zipcode__________

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Last revised: August 29, 2008