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_________________________________