NAMIC Mutual Director Certification Enrollment Form



NAMIC Mutual Director Certification Enrollment Form

Registration Policy | Questions / Support
 PURCHASER PROFILE
* indicates required field

Purchaser:

*
First Name
todo Last Name
todo Suffix‡
  ‡ (Jr., Sr., MBA, etc.)
Company Name: *  
Job Title: *  
todo
Mailing Address: *  
Address 2:
City, State/Province *
 
Zip/Postal Code: *  
Country: *
todo
Telephone: * (ex: (xxx) xxx-xxxx)
Email: *    
todo

 FEES
Fees  

 ADDITIONAL OPTIONS
REQUIRED if you qualify for an event attendance exception:please indicate what year you attended Directors’ Bootcamp 2.0 or the title and dates held of your senior-level position at a mutual insurance company.

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.