A-Pass-Weikel Institute
Kentucky Core Course
REGISTRATION FORM

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

2017
____ Wednesday, October 18, 2017 * Louisville * 4400 Breckenridge Lane #310
____ Thursday, October 19, 2017 * Lexington * 820 Lane Allen Road
____ Wednesday, November 15, 2017 * Louisville * 4400 Breckenridge Lane #310
____ Wednesday, November 22, 2017 * Lexington * 820 Lane Allen Road


***Verify your license number and Continuing Education Status***
The KREC now requires that you provide your license number when you enroll
in continuing education courses and sign attendance roll sheets in class.

Click here to obtain your KREC license number & verify your CE status.

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______

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