A-Pass-Weikel Institute
Two Day Cram Course
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

***2017***
____ January28-29 Louisville * 4400 Breckenridge Lane #310
____ February 3-4 Lexington * 820 Lane Allen Road
____ February 25-26 Louisville * 4400 Breckenridge Lane #310
____ March 18-19 Lexington * 820 Lane Allen Road
____ March 25-26 Louisville * 4400 Breckenridge Lane #310
____ April 22-23 Lexington * 820 Lane Allen Road
____ May 25-26 Louisville * 4400 Breckenridge Lane #310
____ June 24-25 Lexington * 820 Lane Allen Road
____ July 29-30 Louisville * 4400 Breckenridge Lane #310
____ August 26-27 Lexington * 820 Lane Allen Road
____ September 28-29 Louisville * 4400 Breckenridge Lane #310
____ October 21-22 Lexington * 820 Lane Allen Road
____ November 18-19 Louisville * 4400 Breckenridge Lane #310
____ December 16-17 Lexington * 820 Lane Allen Road
***2018***
____ January 27-28 Louisville * 4400 Breckenridge Lane #310
____ February 2-3 Lexington * 820 Lane Allen Road

Class Time: 9:00AM - 5:30 PM
Price:$145.00 for prepayment or $175.00 if paid on the 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_________________________

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