2025 VFIS of North Carolina Broker Seminar Registration Form

**Note: Each person attending the seminar must complete this form.

**Earn 6 Hours of CE Credit**

Courses (Please choose a date and location)

September 8, 2025 - Williamston Fire Dept. - 901 Washington St. Williamston NC 27892

September 9, 2025 - Eastover VFD - 3405 Dunn Rd., Eastover NC 28312

September 10, 2025 - Garner VF & Rescue - 503 W. Main St., Garner NC 27529

September 23, 2025 - Woodfin VFD - 20 New St. Asheville, NC 28804

September 24, 2025 - Cool Springs VFD - 627 Mocksville Rd., Statesville NC 28625

September 25, 2025 - Pinecroft-Sedgefield FD - 2239 Bishop Rd., Greensboro NC 27406

First name

Last name

Date of Birth

Month

Day

Year

NPN Number

SS# (last 5)

Agency Name

Mailing Address

Phone Number

Once this form is submitted, a separate email will be sent to you with confirmation and payment instructions.

Have Questions? Please contact our office at 919-755-1401