Regal School of Real Estate 202 Lake Miriam Drive, Suite E-5
Lakeland, FL 33813
Phone: (863) 602-4113 Fax: (863) 869-8600
Registration Form
Name:_______________________________________ Date: _________
Address:____________________________________________________
Home Phone : __________________ Cell Phone: ___________________
E-mail Address: ___________________ Fax Number: ________________
Social Security Number: ____________________ Date of Birth: _________
Please Initial That You Have Read and Agree To Our Policies _______
Method of Payment: Paypal Check Money Order Cash
Once you have faxed your registration form, we will contact you to arrange payment.
Please Reserve My Seat for the Following Course:
______________________________________________________________
Start Date: _______ Real Estate License Number: ______________ Expires: ______
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