Wisconsin Claims Council

Your Name:
E-Mail Address:
Your Company Name:
Seminar Attending:
Names of Attendees:	Enter names here: : : : : : : : ----------------------------------------- Member Companies NO. OF PEOPLE ATTENDING : X $45.00 each = $ Non-Member Companies NO. OF PEOPLE ATTENDING : X $55.00 each = $

* Please Make Checks Payable to:

WCC or Wisconsin Claims Council

* Mail to:

Wisconsin Claims Council
C/O Eden Vavra
W2580 Zion Church Road
Mayville, WI 53050