Connecticut Chapter CPCU - Meeting Registration Form

If you are a paid CT Chapter CPCU member:  Please simply complete this registration and return it to Joanne Majewski via email or mail (email and mailing address below).

If you are not a paid CT Chapter CPCU member: Please complete this registration with your check for $30 payable to the CT Chapter CPCU, and mail to:

Joanne Majewski
29 Barbour Road
New Britain, CT 06053 

 e-mail Joanne or call her at 860-547-3840 for further information.

Full Name __________________________________________

Company __________________________________________

Phone _____________________________________________

e-mail ______________________________________________ 

Name and designation (s)  for badge _____________________