Your Company Name Here
Vermont Claims Association
Registration Fee: $_____ for Members / _____ for Non-Members
Registration Deadline:
Attendance limited to first Registrants
To register by mail
, Click on this link for a Printable version and mail with your
payment to Vermont Claims Association:
Registration Form
To Pay Online, using your Pay Pal account or by major Credit Cards :
Fill out the
form below, Press the submit button
Your name:
Your email address:
Telephone Number
Employer :
Employer Address
If you intend to obtain any NH
Adjuster
CE credits
or VT
Agent CE credits (if offered)
, please be certain to include
your license number below (please note, we do not need
your social security number for NH license-use the actual
license number).
NH License #
VT Agent License #
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