PAR District 5 REALTORS® Conference
Monday, October 10, 2011
Full Name: __________________________________________________________
Local Association/Board: _______________________________________________
Email Address: _____________________________________________________
License Number (required if requesting CE): ________________________________
Payment received on or before October 1st
# ______PAR REALTOR® Member(s) @ $50 $ _________
# ______Non-Member(s) @ $60 $ _________
Payment received after October 1st
# ______PAR REALTOR® Member(s) @ $60 $ _________
# ______Non-Member(s) @ $70 $ _________
#______ @ $20 $_________
Total Amount Due: $ _________
American Express / MasterCard / Visa (Please circle one)
ü There will be a $2.00 fee for processing credit card payments!
Credit Card #: ________________________________ Exp. Date: ____________
Name on Card (print) ___________________________________________________
Signature of Cardholder _________________________________________________
Fax to Debra Martinez at: 570-268-0266
* Attendees of these sessions are eligible for 3.5 hours of Continuing Education (CE) Credits per session. This session is offered by the PA REALTORS® Institute, which is responsible for course administration.
For more information about this and other PRI courses visit PRI at www.parealtor.org
Transcript fee $20.REALTORS® initially licensed on or after December 1, 2007 are required to take a specific, mandatory course. This session will not fulfill this continuing education requirement.