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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 4:
All Sessions with Lunch
Afternoon Sessions Only – No Lunch

Tuesday, February 5:
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:

 

 

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