12I Compliance Agent (In-Service Online)
Sunday, February 16, 2025
Please complete the following. You will be given an opportunity to confirm all of the data that you enter. An asterisk(*) indicates that a field is required.
Personal Information
The way you enter your name here will be the way your name appears on all event information (name tags, certificates, rosters, etc.).
Prefix:
(Mr., Mrs., Dr., etc.)
First Name*:
Middle Initial
:
Last Name*:
Suffix:
Title*:
Organization*: