VCIA - Annual Conference Registration

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.

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? Please check the box if you wish to have your contact information witheld from the conference attendee list If you have any special needs, please enter them here, or contact the VCIA at 802.658.8242.

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

Conference Registration

Note: You will receive an email confirmation and receipt from VCIA in one - two weeks.

STEP 2: Enter Your Information