Registration Form

Please Print this form, Fill out, and
Mail to:  
                    Ed Kettley, Jr., Instructor
    KETTLEY REALTORS PRE-LICENSING COURSE
                        503 w. Galena Blvd.
                          Aurora, IL 60506

Contact Ed with questions at 630-518-2114 Direct,or
                  Email: kettley1@juno.com

SALESPERSON PRE-LICENSE COURSE:  CLASSROOM  only

Date of Class:________________________________

Location:____________________________________

Name:_________________________________________

Address:_______________________________________

______________________________________________

City/Zip:________________________________________

Social Security #:____________________________
                           (Required for State Licensing)

Home Phone:_______________________________

Work Phone:________________________________

Email:______________________________________

FEES:    Pre-License Course:  $260  includes books/materials
                                               ($50. deposit applies to fee)

Payment by Check or Cash

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