NAPIA - Online Registration

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NAPIA/CAPIA INSURANCE SEMINAR

Marina Del Rey Hotel
Marina Del Rey, CA
March 16, 2010

EVENT REGISTRATION FORM

National Association of Public Insurance Adjusters
21165 Whitfield Place, #105
Potomac Falls, VA 20165
(703) 433-9217
FAX: (703) 433-0369

Please register the following:


             Name: 
        Firm name: 
 Business Address: 
             City: 
            State: 
              Zip: 
   Business Phone: 

       Fax Number: 
           E-mail: 

Is this your first NAPIA meeting:   Yes  No

      Credit Card #: 
    Expiration Date: 
    Credit Card Co.: 
Name on Credit Card: 

Please print my name badge(s) as shown below:

             Name: 
 Spouse / Guest 1: 
          Guest 2: 
          Guest 3: 
          Company: 
             City: 
            State:

REGISTRATION

Attendee	Cost by Feb. 19	Cost after Feb. 19	Quantity
NAPIA and CAPIA Members	$225	$255
Non-Members	$325	$355

CANCELLATION POLICY

A full refund of all event registration fees will be applied to cancellations received up to ten days prior to the seminar. A fifty percent (50%) refund will be issued for cancellations received within 3 days of the seminar. No refund will be issued for cancellations received within 24 hours of the NAPIA event.

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