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  Electrician Registration Form

Complete all blanks to take online course. Texas Department of Licensing and Regulation (TDLR) is the state agency that issued your Electrician’s license. You are registering to take a $25 TEXAS ELECTRICIANS 4-HR. CONTINUING EDUCATION course that is required before your next license renewal.


 Customer Information
Enter a NEW password & username. Use something that you have never used on this page.
Username :  
(Enter a simple one-word user name and remember this for logon purposes)
Password :  
Confirm Password :    
Email Address :
Confirm Email Address :
 
First Name :  
(exactly as shown on your TDLR License)
Last Name :  
(exactly as shown on your TDLR License)
Middle Name or Initial :  
(exactly as shown on your TDLR License)
Name Suffix :  * JR, SR or other click here
(exactly as shown on your TDLR License)
Street Address or PO Box :  
(exactly as shown on your TDLR License)
City :  
(exactly as shown on your TDLR License)
State :  
(exactly as shown on your TDLR License)
Zip Code :  
(exactly as shown on your TDLR License)
Phone # :  
(exactly as shown on your TDLR License)
 
TDLR Electrician License # (Numbers Only):  
(numbers only)
 
Electrician Type :
Expiration Date :   (MM/DD/YYYY)
(exactly as shown on your TDLR License)
 
Personal Information
This personal information is required by the State of Texas for verification purposes while you are taking your online review. It is VERY important that you remember all of these values you are entering below.
Height :  Ft.  Inches.
Weight :  lbs.
Middle Name :  
Eye Color :  
Hair Color :  
Date of Birth : (MM/DD/YYYY)
Place of Birth : City/Town  
State  
Favorite Color :  
Make of Your Vehicle :  
Last 4 Digits of SSN :  
Mother's Maiden Name :  
I certify that I am the person who holds this license and I certify that I am the person who will complete this Continuing Education Course online. I have read and understand TXMH’S payment / refund policy and I agree to abide by the terms therein.

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