Please enter the STUDENT'S information below:

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

Register for 3 or more classes and receive a 25% discount.

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
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: ____/____