CPPC 2012 Spring Workshop Registration Form

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

 SECTION A… Attendees

If this is your first time to attend a CPPC event, please place an asterisk (*) by your name.

1._____________________________________

2._____________________________________

3._____________________________________

4._____________________________________

Company: ______________________________

Address: _______________________________

_____________________________________

Note:  some firms prefer showing a metro area on their name badge.  If YOU prefer a specific listing on your badge, please list here: ______________________________________

______________________________________ 

Email: _________________________________

Tel: ___________________________________

Fax: __________________________________

Workshop Registration Costs… depend upon

WHEN  your registration PAYMENT is received:

Attendees        before 4-1       after 4-1        door

First person       $169           $179             $189

Second person    $159         $169             $179

SECTION B…Guests for food events

Guest tickets for Saturday Evening’s Reception or for any other meals are available for $25 each, per event, if accompanying an attendee.  Otherwise cost is $50 for a non-attendee to participate in any food event.  Please provide the names and payment for any such requests and specify event(s):

1._______________________________   

Event(s):_____________________________

SECTION C…Exhibit Spaces

SECTION D… Advertising/Sponsor Information

If you respond by April 1^st, we will be happy to include your name as a sponsor in our “Official Workshop Program”.  Your Black & White Ad options for listings:

Bronze -    $50   for a business card size ad

Silver -       $100 for a quarter page ad

Gold -        $150 for a half page ad

Platinum -  $250 for a full page ad

Any donation amount is accepted and appreciated and will be acknowledged. If we do NOT receive a special ad from you with your donation, we will prepare a simple “compliments of” type ad for the program on your behalf.

SECTION E… Optional Friday Morning Sessions

April 27th 9-11AM

Agency Round Table   or  

Repair Vendor Only Session

These are optional sessions allowing for open dialogue on subject matter specific to these parties. It allows for open and frank discussions within a controlled environment. It could also allow for review of service issues or repair techniques, depending on the group or the opportunity to discuss other similar business related information. This is an optional gathering and does have a small added cost of $25.00 per person to cover related meeting expenses at the hotel.

AMSA Courses - April 26th   9AM-4PM

These courses are being offered in conjunction with our event again this year, but reservations for these courses will be made direct with AMSA at the following link: www.promover.org (under the training tab)

The cost remains the same as last year and is done in partnership with has been set to at this time to accomplish both events with one travel dollar.

If paying by Visa or Master Card:

Card ______________________________________

Exp. Date: ______________ Security Code: ______

Note: Refunds for reservations are not guaranteed and at the discretion of the CPPC office.