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(Please Provide Individual License Numbers only)

 

Where would you like the study book mailed via USPS?
 

You may also print this form and fax your registration 518-758-6693. 
The Insurance Training Institute accepts personal and business checks the day of class,
but we are unable to process Credit Card transactions.
 PLEASE DO NOT MAIL CHECKS!

Robert T. Secovnie
Insurance Training Institute ( I T I )
20 Spruce Street
Valatie, NY 12184

*REGISTRATION IS ON A FIRST COME FIRST SERVE BASIS