Non-Member Class Payment Authorization Form

This secure form is used to collect credit card payment information for authorized charges made by the Cape Cod & Islands Association of REALTORS (CCIAOR).

There is a $50 fee per CE class for all non-members of CCIAOR.

Fees to attend professional development, certification, or designation courses will be listed in the course listing.

First & Last Name *

License Number *

Phone Number *

Email Address *

How many classes are you currently registering for: *

Please list the Class(es) and the date of the course(es) you are registering for: *

CCIAOR Non-member cancelation policy:

For those who are not active members of CCIAOR, payment is due prior to or at the time of registration for any and all classes. Non-members who register for Continuing Education classes can cancel their registration before the start of the class for a full refund. If a non-member does not attend a class they registered for and has not canceled their registration, no refunds will be issued.

Payment Information

Name on Card *

BIlling Address *

Billing Address Line 2

Billing City *

Billing State *

Billing Zip Code *

Credit Card Type *

Credit Card Number *

Expiration Date *

Signature:
I hereby authorize the Cape Cod & Islands Association of REALTORS® and Multiple Listing Service, Inc. to make authorized charges to my Credit Card listed above, and, if necessary, initiate adjustments for any transactions credited/debited in error. *

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Use your mouse or finger to draw your signature above