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
Please enter my registrations for the workshops checked
below. Check one in each session
A B C
Section I
Section 2
Section 3
Section 4
Section 5
Section 6
Please check one:
YES, I will attend the evening Reception/Vendor Expo. Tuesday 10/13/09
NO, I will not be able to attend the evening Reception/Vendor Expo.
If you intend to obtain any NH CE credits, 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 #
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