CPCU Luncheon - January 22nd 2014

* First Name * Last Name * Please make the following reservation: Cobb Salad: Grilled chicken, ranch dressing Chicken Marsala: Lightly breaded chicken breast sautéed with shallots, garlic, wild mushrooms Butter Basil Pasta: Linguini pasta tossed in a basil butter sauce with fresh vegetables CPCU member: CPCU Member - Not bringing guest($23) CPCU Member - Retired ($15) Non-Member & First Time Guest ($15) Non-Member ($25) CPCU Member ($23) Guest attending________ * Insurance Affiliation Fifth Third Farmers Fremont Insurance Company Harleysville Insurance Company Hastings Mutual Insurance Company Marsh & McLennan State Farm Insurance Company Acuity, A Mutual Insurance Company Others, please specify________ * Please sign up by Monday January 13th. I understand that if I cannot attend the luncheon/workshop I am responsible for the cost of the meal or I will send someone in my place. Please contact Deonia Montgomery @ 616-437-8746. Thank you. I agree