Florida Association of Insurance Agents

On Site Classes Confirmation

Please complete this form only AFTER arranging your courses with the instructor by telephone/email.

On Site classes should be in agency or the member hosting the class should make arrangements for space. Any pricing other than posted at www.faia.com must be approved VP of Education. This form should be completed 30 days prior to the class date. Please use a separate form for EACH TEACHING DATE.



*Required Field

*Instructor:
*Course Requested:
Number of Students Expected:
*Date Of Course:
Times:
*Location: Member must secure space for class
*Agency/Company:
Member #:
*Address:
*Email:
*Contact:
*Telephone:
Fax:
Enter letters EXACTLY as they appear above in the box on the right.