Please enter the STUDENT'S information below:

 Name*:
Address*:
Address:
City*: State*: Zip*:
Home*:
Cell:
Email:
DEL License Number*:
PA License Number:

Continuing Ed class:

Complete this form first then select option to pay via check or charge (online).




Fill out this form and mail it to:
Omega Real Estate School
Administrative Office
4764 Limestone Rd
Wilmington, DE 19808

Please select one of the options below:
_____ Registration fee: 3 Hour course $40.00

_____ Registration fee: 6 Hour course $80.00

____________ Prudential Fox and Roach Agents DISCOUNT CODE

This form can be faxed to: Ruth @ (302) 999-0578

Include credit card info: Card Type: MC / VISA (circle one)

Card Number:_____/_____/_____/_____ Expr Date: ____/____