1) Review our system requirements (at right) to make sure you can print certificates from uiece.com.
										2) Complete this quick registration form. Required information is in bold. 
										
											
												| First Name: |  | 
											
												| Middle Name: |  | 
											
												| Last Name: |  | 
											
												| Company Name (if applicable): |  | 
											
												| Address: |  | 
											
												| Address Line 2: |  | 
											
												| City: |  | 
                                            
												| State: |  | 
											
												| Postal Code: |  | 
											
												| Is Address a Home or Business?: | Home
													
													Business | 
											
												| Daytime Phone (numbers only, include area code!): |  | 
											
												| Fax (numbers only, include area code!): |  | 
											
												| Email: |  | 
											
												| Username (You will login with this. Case-sensitive.): |  | 
											
												| Password (Case-sensitive.): | Show Password | 
											
												| Social Security Number (numbers only, no dashes): |  | 
											
											
												| Insurance License Number (CIPR Number): |  | 
											
												| Reenter Your Insurance License Number (CIPR Number): |  | 
											
												| If your state requires a roster and you type your license number in wrong, there will be a resubmit fee of $5 levied at the time of the second roster submission. Thank you. | 
											
                                            
												| National Producer Number: Click here for information
 |  | 
											
												| Date of Birth (MM/DD/YYYY): |  | 
											
												| Send me occasional e-mail updates about new CE requirement and special offers from United Insurance Educators, Inc. | Yes
													
													No | 
											
												| License Line: | Both
													
													LH
													
													PC | 
											
												| If you have a professional designation, please enter it: |  | 
											
												| Due Date (We will send you a reminder 60 days in advance.) (MM/DD/YYYY) |  | 
											
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