A-Pass-Weikel Institute
Broker Only Review
a Two Day Cram Course
exclusively for Broker Examination Candidates

REGISTRATION FORM

Seating is limited! Reserve your place by printing this form, filling it in, and faxing or mailing it today.
Louisville FAX (502)458-3500

2019
____ February 10-11, 2019 Louisville * 4400 Breckenridge Lane #310
____ April 6-7, 2019 Lexington * 820 Lane Allen Road
____ May 22-23, 2019 Louisville * 4400 Breckenridge Lane #310
____ August 24-25, 2019 Lexington * 820 Lane Allen Road
____ October 26-27, 2019 Louisville * 4400 Breckenridge Lane #310
Additional course dates for 2019-2020 coming soon...

Class Time: 9:00AM - 5:30 PM
Price:$175 for prepayment or $200.00 if paid on day of class.*** Maps & Driving Directions

Note: Please clearly print.

Last Name_____________________________ First Name____________________ MI_____

Home Address________________________________________________________Last 4 of S.S.#_________

City_________________________________ State_______ Zip_____________KREC License#____________

Cell Phone ________________________ Home Phone_________________________ Birth Date___/___/____

Principal Broker ______________________________
Make checks payable to: A-Pass-Weikel
Please bill my ___ MasterCard or ___ Visa for the following amount $_______.

Card #:________________________________ Exp. Date______

Signature___________________________ E-mail____________________________________

Note: No refunds for no-shows. Ten minutes late equals a no-show. Refunds are only issued if we receive written notice 24 hours prior to the beginning of class.
Call Today! Louisville: 502-456-1920 *** Lexington: 859-278-0581
Web Site: www.apassweikel.com *** E-mail: info@apassweikel.com


REGISTER BY MAIL: A-Pass-Weikel Institute, 4400 Breckenridge Lane #310, Louisville, KY 40218