Vermont Claims Association
Attn: Membership Renewal
P.O. Box 1307
Burlington, VT 05402-1307
Rick Irwin, President
Fran O'Connell, Vice President
Deborah Barlow, Secretary/Treasurer
The 2010-2011 membership is upon us! To renew your membership with the Vermont Claims Association, please
complete the form below and submit it to my attention with your check for $20.00 per person.
NOTE: We now offer a Group Rate of $100.00. This will give you 8 membership slots and can be on a revolving basis.
This will allow Companies, with many claim staff, to allow more of their staff to attend the monthly meetings and
educational seminars at the member rates.
Every member needs to fill out a separate form! Please include your e-mail address as we typically email our monthly
notices and any advance notices of upcoming events.
--------------------------------------------------detach and return--------------------------------------------------------
To: Vermont Claims Association
Attention: Deborah Barlow
P.O. Box 1307
Burlington, VT 05402-1307
Please make checks payable to: Vermont Claims Association
Enclosed is $____________ for ___________ membership to the Vermont Claims Association.
Name:_____________________________________________________________________________
Company:__________________________________________________________________________
Mailing Address:_____________________________________________________________________
E-Mail
Address:___________________________________________________________________________
Daytime Telephone Number:___________________________________________________________