CE Seminar Registration Form

Faulkner Education Services
	Insurance Continuing Education \| Insurance Pre-Licensing \| Career Development

CE Seminar Registration Form for Regular Monthly Seminars ONLY:


Please provide the following registration information:

First Name
Last Name
Middle Initial
License #	-We are unable to prepare a course completion certificate without your producer or adjuster license #.
	Click here to obtain your producer or adjuster license #
Company
Street Address
Address (cont.)
City
State
Zip Code
Daytime Phone
E-mail	(we are unable to send a confirmation without your e-mail address)


Enter the date of the seminars for which you are registering (one form per date, please):: -- mm/dd/yy format
Which seminar(s) will you be attending on this date:

	2009 Montana Legislative Changes - $30 - approved for 1 CE hour
	Auto Insurance Hot Buttons - $65 - approved for 4 CE hours
	Avoiding E & O Pitfalls - $60 - approved for 3 CE hours
	Ethics for Insurance Professionals - NEW seminar - $65 - approved for 4 CE hours
	In-Home Businesses - $55 - approved for 3 CE hours
	Health Insurance Basics - $55 - approved for 3 CE hours
	Insurance Tidbits - $55 - approved for 3 CE hours
	Introduction to Commercial Lines - $65 - approved for 4 CE hours
	Liability Insurance - $65 - NEW SEMINAR - approved for 4 CE hours
	Life Insurance Basics - $65 - approved for 4 CE hours
	Personal Auto Policy - $95 - approved for 6 CE hours
	Workers' Compensation or General Liability? - $65 - approved for 4 CE hours


Total cost for all seminars on this date:: (include a $10 last-minute registration fee if you are registering within 5 days of the seminar date)
How will you make payment? Payment is due at registration.: I will mail a check (Your check should be made payable to Faulkner Education Services and mail it to us at 2819 Great Northern Loop, Suite B4, Missoula, Montana 59808. A fee of $25 will be charged for all checks returned by the bank.)
I will pay by credit card via PayPal (You do not need a PayPal account. If you choose this payment method, you will receive an e-mailed invoice from PayPal with a link to their site for processing your credit card payment.)
Enter the e-mail address to which your PayPal invoice should be sent:
Enter your comments:: If you require an accommodation, be sure to include details here

Please note the following details before registering:

Registration and payment are part of your successful course attendance, per ARM 6.6.4203(5). Your failure to attend a seminar in its entirety, or your failure to make payment before the seminar begins, will be considered failure to complete a course and will result in no course completion certificate being issued.

Registration confirmations will be e-mailed to the e-mail address shown above upon our receipt of your payment. Your seat will be held for 5 days or until we receive payment, whichever occurs first. We will continue to hold your seat beyond 5 days so long as the seminar(s) is/are not filled to capacity. You will be notified of any seminar changes/cancellations via e-mail. If you do not provide us with an e-mail address, no registration confirmations or notices of cancellation/change will be sent.

Course Completion Certificates will be provided at the conclusion of each seminar provided that: (a) we received your registration AND payment at least 5 business days before the seminar, and (b) your producer/adjuster license number or social security number appears on the registration form. If we do not provide you with a Course Completion Certificate on the day of the seminar, we will e-mail it to the e-mail address provided on your registration form within 30 days of the seminar, per ARM 6.6.45203(6). Continuing Education credit has been approved by the Montana Insurance Continuing Education Program for all seminars unless indicated otherwise. No Continuing Education Certificates will be given to any registrant who has not made payment or who misses any portion of a seminar. Attendance will be strictly enforced.

Duplicate requests for CE Certificates more than 30 days after a seminar will incur research and processing charges if we are not provided with dates and names of the classes for which duplicates are requested. The charges will be $5 for the first duplicate and $10 for 2 or more duplicates.

Courses repeated during a 24-month period will not earn you double CE credit. We do not maintain records of this nature; it is your responsibility to ensure that you do not repeat our courses during a 24-month period from the first date you take a seminar. NO refunds will be given, after the fact, for repeated courses.

Cancellation/Refund Policy: Failure of the registrant to make payment before the seminar begins will be considered a cancellation by the student per ARM 6.6.4203(5)(d). Full refund/transfer to another seminar will be made if the registrant sends a written or e-mailed request for cancellation that is received in our office no later than 4:00pm on the 5th business day before the seminar. A 75% refund/transfer to another seminar will be made if the registrant sends a written or e-mailed request for cancellation that is received in our office fewer than 5 business days before the seminar or the student arrives on the day of the seminar and has not made payment. No refunds or transfers will be given for students who are no-shows (do not attend and have not called in advance to notify us they will not be attending). Transfers to another seminar must be used within 12 months of the original seminar date.

If we cancel a seminar due to bad weather or if we change the location of a seminar, we will notify you by e-mail at the e-mail address shown above. Cancellations due to bad weather will also be posted on the Home Page of our website at http://www.faulknereducation.com.

A separate registration form should be submitted for each person, for each separate day of classes.

Thank you for your registration!