Please enter the STUDENT'S information below:

ATTENTION: Please enter your name EXACTLY as it appears on your State issued ID.


Name*:
Address*:
Address:
City*: State*: Zip*:
Home*:
Cell: FAX:
Email:

Pre-licensing 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
31299 W. Ocean Dr.
Dagsboro, DE 19939

Please select one of the options below:
Registration Cost: $150.00 ($100.00 non-refundable*) Tuition:$400.00 Total:$550.00 * plus books
_____ Enclosed is $150.00* Registration cost.
Remainder Due at Class Orientation
_____Enclosed is $400.00 includes Tuition Registration Fees.
_____Enclosed $550.00 includes Tuition, Registration Fees, and Required Course Books.
*If course is cancelled or postponed all tuition and registration will be refunded. Books will be delivered at the start of the first class.

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

Card Number:_____/_____/_____/_____ Expr Date: ____/____ CVV Code ______