License Registration

Which seminar are you attending?
California: April 25thCalifornia: May 2ndIllinois: June 13California: June 20California: July 18thHawaii: July 25thWashington: August 8thCalifornia: August 15thCalifornia: August 29thCalifornia: September 12thCalifornia: September 17thCalifornia: September 19thCalifornia: September 19thCalifornia: October 8thCalifornia: October 10thCalifornia: October 29thIllinois: November 12thMidwest/Central: November 14thEast Coast: November 21stEast Coast: December 5th

First Name (required)

Last Name (required)

Your Email (required)

License Number (required)

Street (required)


City (required)


State (required)


Zip (required)

Electronic Signature (required)

By checking this box you are agreeing to electronically sign this form and declaring under penalty of perjury, that you personally attended the stated course, on the listed date(s) and you personally attended the listed hours of coursework.