Registration Form - HighRoad Solution

OFFICE USE ONLY: 52947
Received: _______________
BC Level 1 Licensing:
General Insurance Essentials
Free Information Webinar
November 23, 2016 1-1:30 pm
Entered: ________________
Order Number: ___________
Virtual Course Information Webinar
Registration Form
Your details
Name
Address Line 1
Address Line 2
City
Province
Home phone
(
)
Cellphone
Postal Code
(
)
E-mail
How did you find out about General Insurance Licensing?
How did you find out about the Insurance Institute of BC?
Area of interest:

Broker

Adjuster

Other
TO REGISTER
Please mail, email or fax form to the Insurance Institute of BC - details listed below.
REGISTRATION DEADLINE
November 21, 2016
Confirmation of registration and login details will be emailed to the address provided on this form.
Insurance Institute of British Columbia
1110-800 West Pender Street, Vancouver, BC V6C 2V6 Phone: 604-681-5491 Fax: 604-681-5479
Email: [email protected] www.insuranceinstitute.ca/BritishColumbia