Seating is limited! Reserve your place by printing this form, filling it in, and faxing or mailing it today.
____ Monday, December 11, 2017 * Louisville * 4400 Breckenridge Lane #310
____ Wednesday, December 13, 2017 * Lexington * 820 Lane Allen Road
____ Thursday, December 21, 2017 * Lexington * 820 Lane Allen Road
____ Saturday, December 23, 2017 * Louisville * 4400 Breckenridge Lane #310
Class Time: 9:00AM - 4:00 PM Classroom door closes 10 minutes after the class begins.
Students arriving late according to KREC policy will not be admitted.
Price:$45.00 for prepayment or $55.00 if paid on the day of class. *** Maps & Driving Directions
Note: Please use your name as it appears on your license.
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______
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: email@example.com
REGISTER BY MAIL: A-Pass-Weikel Institute, 4400 Breckenridge Lane #310, Louisville, KY 40218