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REGISTRATION FORM
(On-line registration and payment is available through a link at the CPPC website, www.claimsnet.org )

SECTION A … Attendees

1.______________________________________
2.______________________________________
3.______________________________________
4.______________________________________

Company: _______________________________

Address: ________________________________
________________________________________

Van Line affiliation if a moving agent:
________________________________________

Note:  some firms prefer showing a metro area on the name badge.  If YOU prefer a specific listing, please list here: ___________________________
________________________________________

Email: __________________________________

Tel: ____________________________________

Fax: ____________________________________

Workshop Registration Costs… depend upon WHEN your registration PAYMENT is received:

Attendees         before 9-1        after 9-1          door

First person         $189                        $199                     $209
Second person    $189                        $199                     $209 Any additional      $100                        $110                     $120

SECTION B…Guests
Tickets for Sunday Evening’s Reception, for non-registered guests are available for $25. Please provide the names and payment for any such requests:
1.__________________________________
2.__________________________________

Note: Any and all refunds are at the discretion of the CPPC office, due to schedule times and contractual obligations

Questions?  Contact Alan Jobe at the CPPC Office.

SECTION C… Sponsorship & Donation levels:

The CPPC continues striving to provide the services needed to inform and educate the transit claims industry at a fair price for all involved; while providing an opportunity for our members to network as well. Making these events affordable is made possible by donations and sponsorships to these events.  All donors are appropriately identified throughout our event.  Together we will make a difference.

Platinum Level - $250.00
Gold Level - $150.00
Silver Level    - $100.00
Bronze Level - $50.00

Donation/Sponsorship Amount: ____________

SECTION D… Experience Nashville’s famed “Wildhorse Saloon” with Country Music and Nashville Food Favorites!

Monday October 5th   7- 10PM

$40.00 pp (tax & gratuity included)

Cash bar available.)

Experience the Nashville Scene with a buffet dinner and entertainment at the “Wildhorse Saloon”, a Nashville iconic establishment where known entertainers have made early stage debuts, a short five minute walk from the hotel. Your ticket will get you in the door with designated seating, dinner and non-alcoholic drinks, tax and gratuity while enjoying the night’s entertainment.

“This event is not part of your Convention registration, but is set to give those attending another means of socializing with those in attendance. “  

TOTALS:
Section A    $______________
Section B    $______________
Section C    $______________
Section D    $______________
Grand Total:   $__________

If paying by Visa or Master Card:
Card #__________________________________
Exp. Date: _______________ Security Code: __________
Signature: _______________________________________

If you are not a CPPC member, we will be pleased to provide you with a complimentary one year membership with your registration.

Please initial here: ________            

  

 Claims Prevention and Procedure Council, Inc.
P.O. Box 1117 Newburgh, IN 47629
Ph: 866-276-5656 Fax: 812-858-0599
Email: cppc@claimsnet.org   Web: www.claimsnet.org