REGISTRATION FORM          

PAYMENT PLAN        

Please print  fill out and mail or fax to enroll in classes

Name____________________________________

Address__________________________________

Email Address______________________________

Phone Number_______________   Cell Phone_______________

Please Enroll me in the following classes (Specify Date to attend)

Mandatory________________    City_____________

Elective   _________________   City______________

BICAR    __________________   City______________

Method of Payment  check-Credit Card-Debit Card-or Cash

 We Accept Master Card  Visa or Discover   Credit or Debit Cards

         Visa        MC      Disc   Specify credit or Debit 

Charge the Total Tuition to my card listed below

Card No_________________________ 3 Digit card code_________

Exact Name on Card______________________________________

Expiration Date______________

By submitting this document to Dick Norwood Real Estate Seminars, I certify that I agree with the policies and Procedures of Dick Norwood Real Estate Seminrs.

Card Billing Address_____________________________

Your Signature_________________________________