CPCU Luncheon - November 17, 2015

* First Name * Last Name * Please make the following reservation: Southwestern Grilled Chicken Salad Herb Grilled Chicken Pasta Primavera CPCU member: CPCU Member - Not bringing guest($23) CPCU Member - Retired ($16) 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 no later than November 10. The survey will be closed after November 10. 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 Jennifer Case. (616) 956-4654. Thank you. I agree