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Mutual Insurance Days Registration Form

There is no registration fee for PAMIC Members, however it is necessary to register so we have an accurate count for seating and lunch. Thank you!

* required field

name*  
company  
address*  
city / state / zip code*  
   P Co de*
phone*  
e-mail*  
   

please check all events you will be attending*

Monday, February 5:
Lunch, Roundtable & Legislative Update
Roundtable and/or Legislative Update – No Lunch

Tuesday, February 6:
Breakfast at the Capitol with Legislators
Visits with my State Senator & Representatives

   
my state senator is:   
my state representative is:   

other legislators i would like to visit:   

suggested roundtable discussion topics:

 

 

   > Get directions to the Hilton Harrisburg
   > Download the Registration Flyer

PAMIC • 1017 Mumma Road, Suite 103 • Wormleysburg, PA 17043 • phone 717.303.0197 • fax 717.303.1501 • info@pamic.org