Name:
_________________________________________________________
Address:
_________________________________________________________
City:State:Zip:

_________________________________________________________

Contact Phone: ( ________ ) ___________ - __________________

I want to register for:
    Honolulu - Classroom Program:  AM PM
           Salesperson ($499) 
    Independent Study Course - Salesperson ($450)  Broker ($799)
    Exam Prep Kit (For person with out-of-state license).
            Salesperson ($125) Broker ($175)

(Online Independent Study Course and Online CE Courses, please register and pay online using links provided.)

I want to pay by:
    Personal Check Credit Card (Master Card or Visa only)
   Amount Paid: $450 $499 $799 $140 Deposit
                          Exam Prep Kit: $125 (Sales) $175 (Brokers)
   MasterCard or Visa: __________ - __________ - __________ - __________

   Expiration (mo/yr): _________ / _____________

* Deposit Policy:
Your $140 deposit reserves a seat for you in class. In the event you need to cancel your reservation, notification must be received by 2:00 p.m. on the Friday prior to the first day of class for Honolulu. If notification is not received by this deadline, your deposit will not be refunded, nor can it be used for a future class.

How did you hear about us? _______________________________________

*Please fill out all the information above, print out this page and mail with payment to:

    Vitousek Real Estate School
    PO Box 235846
    Honolulu, HI 96823