National Insurance & Healthcare Continuing Education

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Schedule Onsite Program


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Date of Course Requested*
mm/dd/yy
Time Requested
Location Name*
Location Contact Name
Location Email
Location Phone
Location Address*
City*
State*
Zip
Number of Expected Attendees
License Type of Attendees

(ex. nurse, adjuster, attorney, CCM, etc.)
Topic Request: First Choice
Topic Request: Second Choice
State Credit(s) needed
(Ex: FL, NC)
Sponsor (1)
Sponsor (2)
 
CEUI to arrange for a speaker?
Yes No
 
Person Making Request Information
Person Making Request Name*
Requestor's Phone*
Requestor's Email*
 
Notes and Further Instructions
 


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