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CIC Personal Lines Online Institute

* Prefix
* First Name
Middle Name
* Last Name
Name on badge
* License #
* Date of birth (mm/dd/yyyy)
* Email
* Address Line 1
* City
* State
* State/Province/Region
* Zip
Designations
* Agency or Business Name
* Daytime Phone
Special Request
* Are you taking this seminar for C.E. credit?
* Different Last Name Used Previously for Classes?
* Did you recently switch employers?
If you don't have a PDF of the course learning guide and your 4 links to join from customercare@gotowebinar.com by Tuesday - September 26, 2023, please contact Ray Garcia - ray@iiabaz.com and/or Hunter Rackham - hunter@iiabaz.com right away.
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