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	I am taking this as an NAIC Professional Designation Course.*
	I am taking this for NASBA CPE credit.**
*Designation courses are identified by the icon above. Refer to the brochure to determine whether or not a course is a qualified designation course. NAIC Professional Designations may be earned by those who are employed by a member department and who have formally enrolled in the Designation Program.
**Please note: not all NAIC courses have been pre-approved for NASBA credit.
For more information about NAIC Professional Designation Courses or NASBA qualified courses, contact the Education & Training Department at 816-783-8200.
Payment Method	Check to Follow Credit Card [We will call you to obtain payment information] Bill [Ins. Dept. Staff Only] Zone [Ins. Dept. Staff Only] NIPR Grant Grant [Ins. Dept. Staff Only] Scholarship [Ins. Dept. Staff Only]	Amount

Make Checks Payable to: NAIC
Mail all registration forms containing check or money order to:
NAIC Education & Training, Post Office Box 870335, Kansas City Missouri, 64187-0335