All of the information below is required by the Department of Insurance / Department of Real Estate and will be randomly asked throughout the course to verify the identity of the student taking the course.

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Email (This will also be your username)
Create Account Password
   
First Name
Middle Name
Last Name
**NOTE: THE NAME GIVEN ABOVE MUST BE YOUR LEGAL NAME, AND MUST MATCH THE NAME YOU USE TO APPLY FOR THE LICENSE**
Address
City
State

Zip

Phone Number
Fax Number
Last 4 Numbers of Social Security*
Date of Birth*
mm/dd/yyyy
Company Name
Company Street Address
Company Address Line 2
Company City

Company State
 Company Zip
Company Phone
 
The following questions are required to help us identify you
when you request changes to your account.
 
What is the last letter of the name
of the city that you were born in?
What is the first letter of your
mother’s maiden name?
What month were you born
in (use 1-12 for months)?
What is the last number or letter
of your driver's license number?
What is the last letter of your
mother’s maiden name?
What is your eye color?
What is the first number or letter of
your driver's license number?


Questions in Bold AND Identity Questions Require an Answer.

* This is REQUIRED by the Department of Insurance to report your course hours.

Information regarding our Privacy and Security Policies can be found by clicking here.

After you complete the signup process,
you'll return to www.mikeruss.org where you can LOGIN with the link
in the upper right hand corner.