NAMIC Event Registration

PURCHASER PROFILE

* indicates required field

Purchaser:

First Name

Last Name

Suffix‡

‡ (Jr., Sr., MBA, etc.)

Company Name:

Job Title:

Mailing Address:

Address 2:

City, State/Province

Zip/Postal Code:

Country:

Telephone:

(ex: (xxx) xxx-xxxx)

Email:

FEES

Fees *

PFMM Application Fee (Member) - $50

PFMM Application Fee (Non-Member) - $65

ADDITIONAL OPTIONS

Were you referred by another PFMM?

Yes

If yes, please list his/her name and company.

List your educational experience, designation, association memberships and a short job description for your current position.

Check all the PFMM modules you have completed and include the date and location. Only modules you signed in for will qualify.

Financial Management

Strategic Business Management

Underwriting and Claims

Virtual

Dates and Locations

If you have registered for an event, you are subject to the terms and conditions of participation at this event as contained in the Event Participation Terms and Conditions found at http://www.namic.org/seminars/terms.asp and will be notified to such by the person completing this registration.

NAMIC PFMM Application