WISCONSIN CLAIMS COUNCIL

JOINT CASUALTY & WORKERS COMPENSATION SEMINAR

MAY 13, 2010 – Hilton Garden Inn, 11600 West Park Place, Milwaukee, WI

REGISTRATION FORM (PRINT & MAIL W/PAYMENT)

Company Name: _______________________________________

___ Member ___ Non-Member

Names of Attendees: ___________________________________

___________________________________

Member Companies: # Attendees ____ x $40.00 each = $__________

Non-Members: # Attendees ____ x $50.00 each = $__________

MAKE CHECKS PAYABLE TO: WCC or Wisconsin Claims Council

MAIL TO: Joe Balcaitis, General Casualty

P O Box 1135

Appleton, WI 54912

DEADLINE FOR RESERVATIONS: Friday, April 30, 2010