Register for the Statesboro Seminar

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Use this form to register for the Statesboro Seminar on 10/3/17
 

 

Name:   License No. or SSN:
Address:   Phone No.
City:   Fax 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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  Printable Form
 
   
   
   
   
   
   
J & W Educational Services
1340 Hickory Hill Dr.
Watkinsville, Ga 30677
(706) 769-7112
156 Easy Streeet Milledgeville, Ga., 31061
(678) 806-4262
E-Mail JandW@uga.edu
Sponsored by UGA