Registration Form

1998 DFA Seminar
Registration Form

The fee for enrollment is $475 ($669 Canadian) for CAS members, subscribers and active candidates, and $575 ($809 Canadian) for non-members. An active candidate of the CAS is defined as one who has attempted at least one CAS actuarial exam in the last two calendar years.
The registration fee includes two continental breakfasts, two receptions, a luncheon on Monday, refreshment breaks, and all materials needed for the seminar.
All fees will increase by $50 ($74 Canadian) if registration is received after June 26, 1998. The CAS Office staff will send a confirmation by regular mail to all registered attendees.

CAS Affiliation (please circle one) FCAS   ACAS   Candidate    Subscriber   Other

Name ________________________________________________________

First Name
(as it should appear on badge) ________________________________________________________

Company ________________________________________________________

Address ________________________________________________________

City _____________________________    State _____________   Zip _______________

Business telephone ________________________________________________________

___ Please check here if you have special requirements due to disability.

___ Dietary Restrictions __________________________________________

Fee Enclosed
___ $475 ($669 Canadian) for CAS members, subscribers and active candidates
___ $575 ($809 Canadian) for non-members
___ $238 ($337 Canadian) for moderators and panelists

Method of Payment
___ Check enclosed.
___ Credit card:
    (please circle one)   VISA    MasterCard    American Express    Diners' Club    Discover

Credit card number ________________________________________________________

Expiration date ________________________________________________________

Cardholder's name ____________________________________________

Billing address_______________________________________________

Signature (Credit card payments will not be processed without a signature.)
_______________________________________________________

If paying by check, please print this form and send with your check to: Casualty Actuarial Society, P.O. Box 425, Merrifield, VA 22116-0425.
If paying by credit card, please print and complete this form and return it to: Casualty Actuarial Society, 1100 N. Glebe Road, Suite 600, Arlington, VA 22201-4798; or fax to (703) 276-3108.
Note: Registrations received after June 26, 1998, will incur a $50 late charge. Fees will be refunded for cancellations received in writing at the CAS Office on or before July 3, less a $50 cancellation fee.
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Name	________________________________________________________
First Name (as it should appear on badge)	________________________________________________________
Company	________________________________________________________
Address	________________________________________________________
City _____________________________ State _____________ Zip _______________
Business telephone	________________________________________________________
___ Please check here if you have special requirements due to disability.
___ Dietary Restrictions __________________________________________

Fee Enclosed ___ $475 ($669 Canadian) for CAS members, subscribers and active candidates ___ $575 ($809 Canadian) for non-members ___ $238 ($337 Canadian) for moderators and panelists

Method of Payment ___ Check enclosed. ___ Credit card: (please circle one) VISA MasterCard American Express Diners' Club Discover
Credit card number	________________________________________________________
Expiration date	________________________________________________________
Cardholder's name ____________________________________________
Billing address_______________________________________________
Signature (Credit card payments will not be processed without a signature.) _______________________________________________________