Please enter the STUDENT'S information below:

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

I am a Prudential Fox Roach agent
Please select option 2 or click on Pay Pal and there will be no fee to pay.

Continuing Ed class:

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

(NO FEES for PFR agents but you MUST click this button to register)

Fill out this form and mail it to:
Omega Real Estate School
Administrative Office
21 Tenby Chase
Newark, DE 19711

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

_____ Registration fee: 6 Hour course $80.00

____________ 3 or more classes DISCOUNT CODE

This form can be faxed to: Ruth @ (302) 239-2182

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

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