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CEP Registration Form
Please fill in your details
First Name *
Middle Name *
Last Name *
State License Number *
Employer *
Address *
City *
State *
Zip *
Phone *
Cell
Fax
Email *
Please list the date you would like to attend*
In case the class is full, please indicate a second date that you can attend*
Check # (If sending a Check to us)
Bank Name (If sending a Check to us)
Credit Card Information
Select CC type:
Credit Card #
3/4 digit code on back of the card
Exipiry Date

Payment must be included with the registration form to reserve space. Please submit registration form with payment by mail to IEC, 5809 East Berry Street, Fort Worth, TX 76119 or fax to 817-496-8555. If you have any questions, please call IEC at 817-496-8422.

Cancellation Policy
To receive a full refund, cancellation must be received in writing via fax, mail or email at least one week prior to the seminar. If notification is received less than one week in advance, registration can be transferred to another person at the time of cancellation. If no notice is received, the registration fee will be forfeited. If inclement weather, illness or other unforeseen circumstances prohibits a seminar from being conducted, a full refund will be given to each person registered. Cancellation requests should be submitted to IEC, 5809 East Berry Street, Fort Worth, TX 76119 or they can be faxed to 817-496-8555 or emailed to info@iecfwtc.org.