MAY 2026 Pre-licensing Zoom Course Enrollment Form

ZOOM CLASS ENROLLMENT FORM for Utah Pre-licensing Education

Attendee's Name *

First NameLast Name

Day-time Phone Number*

Format: (000) 000-0000.

E-mail*

Physical Address (for mailing of course materials)*

Street Address

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Comments/Instructions

2026 Utah ZOOM Pre-licensing Course Class Schedule

MAY 26th - 27th (Tues-Wed)

17-01 Utah Life Only Course - Tues, 8am-noon & 1pm-5pm

17-03 Utah Life/Accident-health Course - Tues, 8am-noon & 1pm-5pm, Wed 8am-noon

17-04 Utah Property/Casualty Course - Tues, 8am-noon, Wed, 1pm-5pm

We encourage our students to consider combining the Life Cousre with the Accident-Health Course as it has proven to be the easiest to pass and it combines the two authorities together in just one single exam. Just a thought!

Enrollment Options - MAY 2026 ZOOM Pre-licensing COURSE (choose only one)*

17-03 Life/Accident-health Course$199.00

Tues 8am-noon & 1pm-5pm, Wed 8am-noon

17-04 Utah Property/Casualty Course$199.00

Tues 8am-noon, Wed 1-5pm

17-01 Life Only Pre-licensing Course$169.00

Tues 8am-noon & 1pm-5pm

COMBINATION 17-03 & 17-04 Courses$323.00

Enroll for both now and receive a $75.00 discount

Which Course in April?When will you take the other Course?

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