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: |
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| Middle Name: |
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| Last Name: |
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| Company Name (if applicable): |
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| Address: |
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| Address Line 2: |
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| City: |
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| State: |
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| Postal Code: |
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| Is Address a Home or Business?: |
Home
Business
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| Daytime Phone (numbers only, include area code!): |
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| Fax (numbers only, include area code!): |
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| Email: |
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| Username (You will login with this. Case-sensitive.): |
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| Password (Case-sensitive.): |
Show Password
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| Social Security Number (numbers only, no dashes): |
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| Insurance License Number (CIPR Number): |
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| Reenter Your Insurance License Number (CIPR Number): |
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| 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 |
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| Date of Birth (MM/DD/YYYY): |
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Send me occasional e-mail updates about new CE requirement and special offers from United Insurance Educators, Inc. |
Yes
No
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| License Line: |
Both
LH
PC
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| If you have a professional designation, please enter it: |
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| Due Date (We will send you a reminder 60 days in advance.) (MM/DD/YYYY)
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