Conference Registration

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

PAYING BY CHECK: If you choose to pay by check you must mail your check to VCIA with your completed registration form. Forms received with no check will not be processed. Click below to download a pdf of the form to pay by check.

CAPTIVE CASH: If you are paying with Captive Cash, you must mail the Captive Cash to VCIA with your registration form and payment. Click below to download a pdf of the form to pay with Captive Cash.

Registration Form (use if paying by check or with captive cash)

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? 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.

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