CPCU Luncheon - November 18, 2014

* First Name * Last Name * Please make the following reservation: Chicken Picatta Brocolli Alfredo Italian Wrap (does not come with a side salad) CPCU member: CPCU Member - Not bringing guest($23) CPCU Member - Retired ($16) Non-Member & First Time Guest ($16) Non-Member ($26) 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 at least one week prior to the scheduled meeting. I understand that if I cannot attend the luncheon/workshop and I do not cancel my reservation (5) business days, prior to the meeting, I will be responsible for paying for the lunch. To cancel, please contact Deonia Montgomery. (616) 437-8746. Thank you. Thank You