Prelicense Course Registration – Mississippi IADA

Congratulations on taking the first step towards your future as a successful dealer! Please register below. You may pay securely online or, if you choose not to pay online, an association representative will reach out about payment.

Prelicense Course

Prelicense

Name of Person Taking Course*
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone
Email Address*
Enter Email Confirm Email
Potential Business Name if Known
Date*
Date Format: MM slash DD slash YYYY
Prelicense Course*
- Yes, sign me up for the prelicense course. $395.00
Do you want to pay securely online?*
- Yes, I want to pay securely online.
- No, I will mail my check or call the office.
BILLING Address - Must match card.
Street Address Address Line 2 City State ZIP Code
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00
Agreement and Understanding*
By submitting this form, I agree to the following statement.
I, the person named on this form, acknowledge that I am the one completing the class and it is my responsibility to review fully and completely both the online materials and the additional companion materials of the Prelicense class. I understand that if I have any questions regarding the content, it is my responsibility to contact Tony Lawler or Erin Holden at 601-939-9866.

The online portion of the course materials, a pdf, will be provided after submission of this form.
Name
This field is for validation purposes and should be left unchanged.