CPPC 2023 Convention Registration Page

REGISTRATION FORM

(Downloadable registration form is available through a link at the CPPC website, www.claimsnet.org & Payment is available through a secure on-line payment portal) 

SECTION A… Attendees
If this is your first time attending 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: _____________________Textable: Y: ____ N:____

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

Attendees                     before 8-1        after 8-1    

First person                 $289                  $314           Second person            $279                  $204            
Any additional             $269                  $294            

SECTION B…Guests for reception or other food events:

Guest tickets, for a non-registered attendee to attend any meal event is $75 per person per meal. Please provide the names for each person and meal event attending:

1.____________________ Event:__________________

2.____________________ Event:__________________

3.____________________ Event:__________________
______________________________________________
SECTION C…Qualified Claims Analyst ”QCA” Course Thursday September 21^st  

This is a stand-alone course option separate from the CPPC 2023 Convention.  Participation includes course material, lunch and conclusion exam for certification.  The cost for the course is $275.00 per person.

Name: _______________________________________

Name: _______________________________________

Friday Sept 22^nd - “Pre-Convention” Optional Sessions:

“Military Round Table”, “Repair Only” &
“Carrier, Agent & Insurance”

These sessions are at no additional charge to attendees, but we do need a count for appropriate planning.  Please advise if you will be attending one of these sessions.

Name: __________________ Session: _____________

Name: __________________ Session: _____________

Name: __________________ Session: _____________

SECTION D… Advertising/Sponsorship Information

Special Sponsorships are available on a first come basis
for those that want to do more than the usual Advertising
in the Program and includes a program ad and event
banner as well.

Name Badge Sponsor:                      Taken
Program Sponsor:                             $750.00
Audio Visual Sponsor               Negotiable / Shared * Reception:                                Negotiable / Shared *
Military Roundtable Sponsor:   Negotiable / Shared *
Repair Only Sponsor:                Negotiable / Shared *
Break Sponsor:                         Negotiable / Shared *
Meal Sponsor:                           Negotiable / Shared *

“ * “ Negotiable amounts are at a minimum of $500 and can be a combination of Sponsors.

If you respond by September 7^th, we will be happy to
include your name as a sponsor in our
“Official Convention Program” along with a
corresponding Ad and an event banner. 

Your Black & White Ad options for listings:
Advertising:
Bronze -         Business card Ad                 $50
Silver -           Quarter page Ad                   $100
Gold -             Half page Ad                        $150
Platinum -      Full page Ad                         $250 

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

Show your support by placing an ad, even if you
are not able to attend this year. 

Remember the deadline is 9-7-2023!

(We cannot guarantee your inclusion in the program
after this date.)

Note:  Most named Sponsorship opportunities
are available upon request and prices are
negotiable. Contact the CPPC office to discuss. 

TOTALS:
Section A: $___________       Section C: $____________
Section B: $___________       Section D: $____________

                                      Grand Total: $____________ 

Upon receipt of the registration form, an invoice will be emailed to you for payment by check or through our secure on-line payment portal. If submitting payment by credit card, please include standard cc information and the zip code associated with the card.

Number:____________________Exp:____
Zip Code:_________

If you are not a current CPPC member, or have not previously been a member, we will provide you with a one-year membership with your registration.  Please initial here if being requested: _____ 

Refunds for any processed reservations are not guaranteed and are at the discretion of the CPPC office.

QUESTIONS?  Call the CPPC office at
812-858=0575, email at cppc@claimsnet.org,
or by mail at P.O. Box 1117 Newburgh, IN 47629