Complete, copy, and return this form for each attendee along with a CHECK (Credit Cards Not Accepted) made payable to the IWCF (International Workers’ Compensation Foundation) and mail to: IWCF, Post Office Box 11697, Daytona Beach, FL, 32120-1697.
Registration Fees: |
$200.00 per person paid prior to 8/l/98 (early bird rate) |
$225.00 per person paid prior to 9/l/98 |
|
$275.00 paid after 9/l/98 |
Groups of 10 or more from the same employer receive a $50 per person reduction.
(Registration fee includes conference materials and special functions, including two continental breakfasts, one evening reception, and one luncheon.)
Name:
__________________________________________________________________________________
(Please PRINT name as you wish it to appear
on your name tag)
Business Name: ___________________________________ Title: ___________________________________
Address: ________________________________________________________________________________
City: ___________________________________________ State: _________________ Zip: ______________
Telephone: (____)_________________________________ Fax: (____)_______________________________
If you are an Adjuster and desire educational credits, please provide your Social Security Number: ____________ If you are an Attorney and desire educational credits, please provide your N.C. State Bar Number: ____________
Area of Practice: O Employer O Employee O
Insurer O TPA O Attorney O
Mediator
O Health Care Provider O Rehab Specialist
Other: ______________________________
LODGING—A conference rate of $90 (single or double plus applicable tax) will be available to you at the Sheraton Imperial Hotel until 8/13/98, unless this block of rooms becomes fully reserved prior to this date, so register early! The Sheraton Imperial offers southern hospitality and a convenient location, just three miles from Raleigh-Durham International Airport. Indicate you are attending the Third North Carolina Workers’ Compensation Educational Conference when calling to make your reservations. The Sheraton’s toll free number is (800) 325-3535 or you may dial direct, (919) 941-5050 or fax (919) 941-5156. The Sheraton Imperial is located in the Research Triangle Park, Durham. Use exit 282, Page Road off Interstate 40. Hotel reservations alone do not guarantee admission to the conference.
CONTINUING EDUCATION CREDITS—Application will be made for CLE, Adjuster CEU’s and CRC, CDMS, CCM credits.
CANCELLATION REFUND POLICY—Cancellation of pre-registration must be made before 5:00 pm on 9/4/98. Substitution of personnel is recommended in lieu of cancellation after that date. The full registration fee will be forfeited if you fail to attend or cancel timely.
SPECIAL NEEDS—Individuals attending the conference who may need auxiliary aids or special services are requested to provide notice of their needs in writing no later than 10 working days before the conference so that appropriate arrangements can be made.
DRESS CODE—Casual clothing is appropriate for all events.
For further information, contact the IWCF office at (904) 252-2013.
Net proceeds from this event, if any, go to the International Workers’ Compensation Foundation (FEIN# 3 5-1737364), a non-profit organization, to further its work in workers’ compensation education and research.
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