Registrant

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Name

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First Name (as it should appear on badge)

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Company

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Address

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City State Zip

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Business Telephone

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 Please check here if you have any special requirements due to disability

 Luncheon Special Meal Requirements:

 Fruite Plate    Vegetarian    Kosher

CAS Affiliation:

______FCAS ______ACAS ______Candidate ______Subscriber

______Affiliate Member ______Academic Correspondent

Other ___________________________________________

Registration Fees

 CAS Members and Active Candidates $500 ($728 Canadian)

 Nonmembers $600 ($873 Canadian)

 Member Speakers $250 ($366 Canadian)

Method of Payment

 Check enclosed for the amount ___________________

 Credit Card for the amount ______________________ (please check one):

 Visa  MasterCard  American Express  Diners Club  Discover

Card Number: _____________________________Expiration Date: _________________________

Cardholder’s Name: _______________________________________________________________

Billing Address: ___________________________________________________________________

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Signature (Credit Card payments will not be processed without a signature)

If paying by check
Complete this form and send with check made payable to:
Casualty Actuarial Society
P.O. Box 425
Merrifield, VA 22116-0425

If paying by credit card
Complete this form and return to:
Casualty Actuarial Society
1100 North Glebe Road
Suite 250
Arlington, VA 22203-4798

OR fax to: (703) 276-3108

If you fax in your registration with credit card information, please do not submit the original form as well– this may cause a duplicate charge to your credit card. All Credit Card payments will be processed in U.S. Dollars

Note: Registrations received after June 1, 2000 will incur a $50 late charge. Fees will be refunded for cancellations received in writing at the CAS Office on or before June 8, 2000, less a $50 processing fee.