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Insurance Pre-License Seminar Registration

There are four ways to register for an ABRC® seminar

  1. Complete the registration below and press "Enter Information" to e-mail your order to us. We will confirm your registration by e-mail on our next business day.

  2. Complete the registration below. You may then print this page, fill in your MasterCard, Visa or Discover card information by hand after it has been printed, and then fax the completed form to us 24 hours a day at (217) 753-1574.

  3. Register by phone, charging to your MasterCard, Visa or Discover card. Call toll-free at 1-888-753-2272.

  4. Complete the registration below. You may then print this page and mail your registration with your check or money order to ABRC®, 3 Lawrence Square, Springfield, IL 62704.
Please complete all registration fields!
 


For the $240.00 enclosed, please enroll me in the Life, Accident, and Health Seminar on:
  at  
(date) (city)
 
For the $240.00 enclosed, please enroll me in the Property/Casualty Seminar on:
  at  
(date) (city) 
 
For the $375.00 enclosed, please enroll me in both seminars:
Life, Accident, and Health Seminar on:
  at  
(date) (city)
and the
Property/Casualty Seminar on:
  at  
(date) (city)

This represents a $105 discount off the cost of registering for each seminar separately.
Price Includes the all new, up-to-date ABRC Seminar workbook and practice questions and answers. No additional study books are required. If you are unable to attend as registered, we will re-register you to another date or location up to one year from the original date registered. If notified at least 48 hours in advance of the original date registered, we will refund your money with only a $15 registration/administrative charge applying. Prices and terms of this offer as well as this schedule are subject to change without notice.

Your Name
     
Home Street Address
     
City
     
State
     
Zip
     
     
Social Security Number
     
Telephone Number
     
Email
     
Agency or Company Representing
(if affiliated -- no affiliation required)
     
Manager's Name
     
Agency or Company Street Address
     
Agency or Company City
     
Agency or Company State
     
Agency or Company Zip
     
Agency or Company Telephone Number
     
Agency or Company Fax Number
     

  Payment Method:
      MasterCard VISA Discover Card Check Money Order

Credit Card Number
     

Expires
     

Card ID (3 numbers located on back of card)
     

Name as it Appears on Card
     
 
Credit Card Billing Address
     
 
  Are you associated with a PIIAI member agency?
 
     

Please complete all order fields!

   
If you have any questions, or need additional
information, please call 1-888-753-ABRC toll free.
 
 

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