Continued Education Registration Form

**MUST FILL OUT A REGISTRATION FORM FOR EACH CLASS DATE ATTENDING**

Name * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number * - (###) - ### ####
Best phone number to reach you at.
Email *

A confirmation email for your registration will be sent to this email address.
Visit this website if you do not know your license number
https://eservices.iowa.gov/licensediniowa/
Professional License Number *

Go to this website to look up your license number if you do not know it https://eservices.iowa.gov/licensediniowa/
Location & Date Attending *
Hours Attending *
LA' JAMES GRADUATES MUST PRE-REGISTER AND PROVIDE A COPY OF THEIR DIPLOMA WITH REGISTRATION TO RECEIVE THE CLASS FREE OF CHARGE
Are you a LJIC graduate? *
If so, when did you graduate?
What LJIC location did you graduate from?
Last name at time of graduation
Upload an image of your diploma here
Con Ed & Law: Pre-registered $50/$60 at the DOOR
Law Class Only: Pre-registered $30/$40 at the DOOR
Form of payment *
Credit Card Number
Expiration Date
CSV

3 digit code located on the back of your credit card
You can remit your payment in any one of the following ways:
1. Complete this form and submit with your credit card information
2. Drop off payment and this completed form
3. Mail form and payment to:

La' James International College
2419 5th Ave S
Fort Dodge, IA 50501

4. Call 888-289-2513 and fill out a form over the phone
La' James reserves the right to cancel any class due to inclement weather or lack of sufficient registration. Party submitting registration will be notified prior to date of class of any cancellation. Registration fee is non-refundable due to your failure to notify class site within 7 days prior to class of inability to attend.

Continued Education Registration Form

Continued Education Registration Form

Visit this website if you do not know your license number https://eservices.iowa.gov/licensediniowa/

LA' JAMES GRADUATES MUST PRE-REGISTER AND PROVIDE A COPY OF THEIR DIPLOMA WITH REGISTRATION TO RECEIVE THE CLASS FREE OF CHARGE

Con Ed & Law: Pre-registered $50/$60 at the DOOR Law Class Only: Pre-registered $30/$40 at the DOOR

Visit this website if you do not know your license number
https://eservices.iowa.gov/licensediniowa/

Con Ed & Law: Pre-registered $50/$60 at the DOOR
Law Class Only: Pre-registered $30/$40 at the DOOR