2018 IA-NEIASIU Registration form

2018 Insurance Fraud Training Seminar & Exhibitor Hall

Presented by: Iowa-Nebraska Chapter of the International Association of Special Investigation Units

Registration Form

Name

Company/Agency

Address

City

State

Zip

Phone Number

Email

Check all that apply:

Attending President's Reception Vegetarian lunch Gluten free lunch

Registration Fee before 4/10/2018

Regular & Supporting Partner $175 Associate $90 Non-Member Private Industry (Insurance, Attorney...) $200 Non-Member Public Service (Police, Fire, State, Fed...) $100 Non SIU Insurance Adjuster or Public Agenacy 1 day rate $85 ALL REGISTRATIONS AFTER 4/10/2018 $200

15% group discount (6 or more) - register by mail only

Register & pay online with a credit card

Register by mail - send check payable to:

IA-NEIASIU
POB 535
Omaha, NE 68108-0535

Cancellation Policy:
No refunds after 4/10/2108

Lodging

COURTYARD BY MARRIOTT
2405 Creekview Drive
Ankeny, IA 50021

Room Rates:

Single or Double $114
(Rate available until 4/10/2018)

Reservations:
(515) 422-5555 / Group Name: "IA-NE IASIU"

Seminar & Registration Questions

Call us:

Gus Hitz (402) 619-8184 or
Nicole Mann (402) 676-8461

Email: board@ia-neiasiu.com

Online: http://ia-neiasiu.com