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REGISTRATION FORM

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First Name: *

Last Name: *

Address: *

E-mail address: *

City: *

State: *

Zip Code: * (#####)

Date of Birth: * (MM-DD-YYYY)

Social Security #: * (###-##-####)

Cell #: * ((###) ###-####)

Alternate Phone #: * ((###) ###-####)

I hereby Signing this enrollment form understand that I can only attend the classes via web cam using PC, Lap top and or iPad, I understand that I am NOT allowed to access the class via iPhone or any other data Phone, I understand that I must attend the class via web cam from a quite and personal space and be alert and attentive at all time, furthermore I understand that at all times I am bound by any other provisions or rules given to me by the instructor at any time during the course of my class, violation of such rules, terms, and provision will be cause for immediate termination, and possible ban from obtaining insurance licenses from California Department of Insurance.

If a student withdraws and does not reschedule, the following will apply:
Students who fail to attend have the option to re-schedule within 3 MONTHS from the original class enrolled at NO extra charge. Minimum standards for our program studies are set by the California Department of Insurance, 320 Capitol Mall, Sacramento, CA 95814.

I Agree to comply with all terms and attendance Rules set forth by Cyber Insurance School

Refund or Cancellation POLICY:
I Agree that I cannot dispute the charge that I authorized to pay for my Class by my credit or Debit card to CIS with my Bank and must go through Cyber Insurance School Admission Department for Cancellation or Refund. I understand that if I violate this Agreement I be charged a Fee of $49.00

I Agree to comply with all terms set forth by Cyber Insurance School. Also I understand because upon submission of payment I immediately receive access to the Course that I purchased Cyber Insurance School has no refund policy and this transaction is final.

It is the State Government that will ultimately issue “A” “License” of all different form, Cyber Insurance School has NO role or decision making power in that process, so be advised that California Department of Insurance can revoke or deny “A” “License” at its own discretion. IF you believe that your Record is tainted please make sure to communicate directly with CA Dept. of Insurance, Cyber Insurance School Instructor, Staff are prohibited to provide you with any advice or suggestions other than directing you to CA Dept. Of Insurance for all your question with regard to your personal matters.

I Agree to all of the CA Dept of Insurance Rules and Regulations. That under CA penalty laws that my personal information and address is accurate.

How did you hear about Cyber Insurance School. Please be specific and provide the name or source:*

Company Affiliation. Please be specific and provide the name of your employer's Agency and Recruiter, phone number and address: *

SSL Privacy Policy NOTICE:

We understand how important your privacy is to you, so we are committed to assuring your privacy. We use SSL-encryption technology when transferring and receiving consumer data on our and our affiliates' websites to protect your personal information. Additional information on how your personal information is used and disclosed is contained in our complete Private Policy (View Cyber Insurance School entire Privacy Policy). I understand that by submitting my Registration form I am agreeing to the terms of Cyber Insurance School Privacy Policy Agreement.

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If you intend to pay with American Express please contact admission toll free 1-877-800-2822