NAPIA - Online Registration

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FPCC WEST INSURANCE SEMINAR

The Marina del Rey Hotel
Marina del Rey, CA
March 21, 2012

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 #: 
Expire Date & CVC #: 
        Credit Card: 
       Name on Card: 

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

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

REGISTRATION

Attendee	By Feb 20th	Ater Feb 20th	Quantity
Member	$250	$275
Non-Members	$350	$375

CANCELLATION POLICY

A full refund of all 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 refunds will be issued for cancellations received after March 17.

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