SECURE - SELF STUDY REGISTRATION FORM
Very Important! If you've already registered for a Self Study Course within that last month, please continue to use the same Login Information that was originally emailed to you! Click HERE to login in! There is no need to re-register for additional courses! We will send receipts off to you for additional courses completed!
Tip - to get to the next field use the "tab" key because if you use the "enter" key you will submit your form too soon!
Important read this first - you must be sure to type your information properly. PLEASE DO NOT USE ALL CAPITAL LETTERS or all small letters because your certificate will print the way you entered your information on this form.
Example ROBERT SMITH = WRONG robert smith = wrong Robert Smith = Correct
Your Contact Details: Before you register - please see the above in RED!
I will mail my cheque I will send my cheque by ICS
e-Transfer
I will pay by credit card
* EXAMPLE - 5555 4444 3333 2222
CVV2 # (3 Digit Code on the back of your Credit Card)
Mail or ICS cheques to
Self Study Course Costs:
What is the cost? - Course is based on the total credit hours X $10.00 per credit hour + GST Example - 3 hour course = $30.00 + 5% GST (add $12.00 shipping & handling for courses not completed online)
Method of study: You MUST choose one of the following
I will do my course/s online (username & password will be E-mailed to you within one minute) I would like the course/s sent to me by Express Post or ICS
(Valid in Quebec if you are a resident of Quebec)
Recognition number: CSF15-03-33682 Number of PDUs: 5
Number of PDUs and topics:2 in General subject1 in Group savings plan brokerage1 in Insurance of persons 1 in Group insurance of persons
(Valid in Quebec if you are a resident of Quebec) Recognition number: CSF15-03-33683
Number of PDUs: 5
Recognition number: CSF15-03-33684
Number of PDUs and topics:4 in General subject1 in Insurance of pearsons
Recognition number: CSF15-03-33685
Number of PDUs and topics: 2 in General subject3 in Insurance of persons
Recognition number: CSF11-08-25664
Recognition number: CSF11-07-25647
Number of PDUs and topics: 5 in General subject3 in Insurance of persons
Recognition number: CSF15-03-33686
Number of PDUs and topics:5 in Compliance
Recognition number: CSF15-03-33687
Recognition number: CSF15-03-33688
Recognition number: CSF15-03-33689
Number of PDUs and topics: 2 in General subject1 in Insurance of persons 2 in Compliance
Recognition number: CSF17-10-40488
Number of PDUs and topics: 1 in General subject1 in Insurance of persons 3 in Compliance
Recognition number: CSF17-10-40487
Number of PDUs and topics: 1 in General subject3 in Insurance of persons 1 in Group insurance of persons
Order Sub Total
Shipping & Handling
TAX (determined by your province)
Total for this Order
Type 1234 in the box to the right then click Submit Form:
203-4438 Ontario Street, Beamsville, ON Canada L3J 0A4
Toll Free Phone 877 524-7121 Toll Free Fax - 866 277-4511
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