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MD Course Coordinator Form

PDF · 24 Oct 2025

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A one-page Maryland Insurance Administration Continuing Education Course Coordinator Registration form for provider The Intelligent Agent, LLC (Provider No. 235969). It registers Jarred Chappell as Course Coordinator for the course “Commercial Foundations,” lists coordinator contact details, marks applicable qualifications, describes coordinator compliance responsibilities, and includes an attestation and signature dated 10/24/25.