Registration Form - May 9, 2019

Dallas / Fort Worth Chapter ISCEBS

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- Gamma Iota Sigma
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WELCOME
- About Us
- BOARD OF DIRECTORS
EVENTS
Membership
CEBS Program
- Gamma Iota Sigma
Resources
- Past Presentations >
Sponsorships
Job Postings
Contact Us

Registration Form - May 9, 2019

Please complete this form to register for the: CE DAY
Please make note of the meeting time and location: Maggiano's Little Italy (Northpark Center) 205 N Park Ctr.
Dallas, Texas, 75225 11:30 AM - 1:00 PM

CONTINUING EDUCATION:

Approved for seven (7) hours of TDI credit

This program qualifies for up to seven (7) CEBS Compliance credits. Visit www.cebs.org/compliance.com for more information.

* Indicates required field

Name: *

First

Last

Email: *

Company: *

Phone Number: *

Please Select ONE of the following options: *

Please select your payment options: *

PayPal (Once you hit submit you will be directed to the payment page to complete your registration payment) Pay at the Door (Please bring your check with you on the day of the program)

Are you a DFW ISCEBS Chapter member? *

Yes No No, but I am interested in local membership

Check all that apply: *

CEBS GBA RPA CMS

Please list your business role: *

Plan Sponsor Consultant Carrier Administrator Provider Other

Please list below: *

By completing this form, do you agree to pay the fee? *

Yes No

Would you like to be added to the Chapter's emailing list? *

Yes

This list is used for Chapter communications to promote upcoming educational and networking events.

Please make checks payable to: DFW ISCEBS

Comments or Questions: *

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