Registration Form

Registration is required: Additional Attendees: $20off each additional pre-registered seminar attendee after the first pre-registration is paid. Registration cut off date is the Tuesday before each seminar date. No refunds allowed, however, a credit (minus a $100 change fee) may be applied to another PMB seminar (if space permits) with a 14 day notice of cancellation.
Agency Information:
Agency Name:
Address:
City:
State:
Zip:
Contact Name:
Title:
Agency Main Phone: - -
Email:
How did your hear
about PMB Seminar:
Billing Tip:
Always make sure your RAP is paid before you bill your Final
Claim, unless you are billing a LUPA in which case you don’t
have to have a paid RAP in the system.
Seminar Information:
AttendeeTitle AttendeeName AttendeeEmail SeminarAttending DaysAttending

*Discounts will be calculated in the next step

Registration Total: