Register for the Columbus Seminar
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Use this form to register for the Columbus Seminar on 9/19/17
 

 
Name:   License No. :
Address:   Last four SSN:
City:   Phone No.
State:   E-mail Address:
Zip Code:   Company Name:

Click the box or boxes for the states in which you hold a license.
GA

NC

 AL KY MD
  If you need credit for NC enter the last four of SSN:
 

Pay at Door

  

 Mail Check

  

Invoice

  

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J & W Educational Services
1340 Hickory Hill Dr.
Watkinsville, Ga 30677
(706) 769-7112		 156 Easy Street  Milledgeville, Ga., 31061
(678) 806-4262
E-Mail JandW@uga.edu
Sponsored by UGA