Tulsa School of Real Estate

Continuing Education Online Course Registration Form
All information is required unless otherwise noted.
Name ________________________________________ Date ___________________

OREC License Number _________________________________________ (REQUIRED)

Mailing address ________________________________________________________

City/State _______________________________ Zip _________________________

Day telephone _________________________ Evening ________________________

Cell _____________________________ Fax ________________________________

Email ________________________________________________________________

How did you hear about us?

Sales Representative (name) _________________________________________,

internet search, OREC, other _________________________________________

AGREEMENT:

I, ___________________________________ (please print your name) hereby enroll in
PLEASE CHECK THE ONE THAT APPLIES

____ the full 21 hours of continuing education ____ the continuing education course(s) I have purchased at TULSA SCHOOL OF REAL ESTATE. I agree to pay tuition of $79.99 for the 21 hour option OR $15.00 for any individual course(s). I agree to pay an administrative fee of $25.00 for returned checks. No refunds will be available for tuition after 3 business days from the date of my enrollment.
I understand that my enrollment is only valid for 6 months from the date on this registration form. If I have not completed the course(s) and the end-of-course tests within 6 months of my enrollment I will have to re-enroll, and pay for the course again.

I have read the agreement and certify that I am the above named person.

Signature ____________________________________
Date __________________________________

Credit Card Information

Check one:  __   __   __   __ 

PLEASE PRINT Name exactly as shown on credit card,

______________________________________________________________________

Credit card number:

______________________________________________________________________

Exp Date: _____ /_____ CCV#: _____

Billing address if different from mailing address.

Billing address ________________________________________________________

City/State _______________________________ Zip _________________________

I authorize Tulsa School Of Real Estate to charge my credit card account in the amount of $_______ for the products listed above.

Signature: _________________________________________ Date: ______________

Please remit this form with payment to TSORE:
6817 East 57th Street, Tulsa, OK 74145