Duplicate of lafayette - Licensed to Build

Primerica Office

913 S. College Rd., Suite 210

LAFAYETTE, LA 70503

Dec. 16-17th, 2017

Saturday Dec. 16, 2017 12PM-8PM

Sunday Dec. 17, 2017 9AM-7PM (Lunch 12-1)

This class taught by: Tammy Dufrene (504)421-4342

Select Options

Lafayette

Name

First Name

Last Name

Solution #

Address

Address1

Address 2

City

State

Zip

Cell Phone

Area Code

Phone First 3

Phone Last 4

Email

RVP Name

Select Options

Option 1: Deposit= $50 (Remaining balance will be charged day of class.)

Option 2: Pay in Full= $100

Credit Card Number

Today's Date

Card Expiration Date

3-Digit Security Number

Name As It Appears On Card

Billing Zip Code

Card Type

Visa

Mastercard

Submit

Lafayette Registration