Conference Registration

Note: You will receive an email confirmation in one - two weeks.

CAPTIVE CASH: If you are paying with Captive Cash, you must mail the Captive Cash to VCIA with your registration form and payment.

PAYING BY CHECK: If you choose to pay by check you must mail your check to VCIA with your form. Forms received with no check will not be processed.

STEP 2: Enter Your Information

First Name* Middle Initial Last Name* Nickname for badge* Title* Company*

Note to Captives: Please enter name of Captive Insurance Company in the Company field above, not parent company.

Industry Type (Captives only) Domicile Mailing Address 1* Address 2 City* State/Province* Zip Code* Country* Direct phone and extension* Fax Email* Are you a first-time conference attendee?

CPE and CLE credits are available to those who participate in conference seminars. Participants are required to sign in to each seminar to be eligible for credit. To view general information on VCIA as a NASBA sponsor, please click here

How did you learn of this event? Do you wish to be listed on the conference attendee list (emails will not be released) If you have any special needs, please enter them here, or contact the VCIA at 802.658.8242.

Note: Pre-Conference Workshops on August 11th, add $75 per workshop to the payment amount (Captives 101 and Captives 102).

Note: Art Studio Tour and Luncheon, add $60 to the payment amount.

Payment Options Payment type Payment Amount Credit card type Credit Card Number Expiration Month Expiration Year Name as it appears on card