Reg IV

* Indicates required field

IAIP Class Selection

Classes *

1 - 4 - Generations, Ethics and the Workplace

Please read the following notes
To Register -- Complete class registration by clicking the green "Register For Class" button in the bottom right of this form. All required information (indicated by *) must be included for the registration to process.

After registration is submitted you may automatically be directed to the payment page. You do NOT need a PayPal account to process payment via debit/credit card.

All those registering for these courses will receive information about attending procedures from jkholstine@insuranceeducators.net. Please check your spam folder if you do not receive these emails by the day prior to the event. If not received, please contact Janet K Holstine at email jkholstine@insuranceeducators.net or phone or text 269-323-2042.

Thank you for your registration. See you at the event for which you registered. Please contact me with questions.

Janet K Holstine at email jkholstine@insuranceeducators.net
phone or text 269-323-2042.

Your Information

First Name *

Middle Initial *

Last Name *

Preferred Name *

Personal Email *

Business Email *

Mobile Phone Number *

Business Phone Number *

System ID / License Number / NPN if CE is requested *

Organization/Work place *

City *

State *

Current Designations *

Comments *

THANK YOU for registering for the Region IV courses.

PLEASE NOTE: No information provided will be shared with others and will only be used to contact the registrant.

Email is our default & preferred method of communication. Please provide your business AND personal email. This is necessary as we may need to contact you outside normal work hours or in the event there is an error in your email address. Cell phone numbers may be used to text if email bounces back. As a final means of contact, we will call during work hours if possible.

IAIP Class Selection​

Your Information

IAIP Class Selection