CPCU Dinner - October 17, 2017

* First Name * Last Name * Please make the following reservation: Smothered Chicken 6oz Barrel Cut Sirloin Basil Butter Pasta * 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 October 12. The survey will be closed after October 12. I understand that if I cannot attend the dinner and I do not cancel my reservation (5) business days prior to the dinner, I will be responsible for paying for the dinner. To cancel, please contact Amanda Boring. (616) 325-6011. Thank you. I agree