REGISTRATION APPLICATION

ILLINOIS SELF-INSURERS’ ASSOCIATION

TWO DAY BASIC NUTS & BOLTS WORKSHOP

TUESDAY, APRIL 26, 2016

AND

WEDNESDAY, APRIL 79, 2016

NAME _______________________________________________________________

TITLE ________________________________________________________________

COMPANY ____________________________________________________________

STREET ADDRESS ______________________________________________________

CITY ___________________________________   STATE _______   ZIP ___________

TELEPHONE __________________________________________________________

E-MAIL ADDRESS ______________________________________________________

TUITION for the 2016 Two Day Basic Nuts & Bolts Workshop is $195 for Members and $250 for Non-Members.  It includes course materials, continental breakfast, lunch and two coffee breaks for both days.  The program offers MCLE, CWCP, CRCC and CCMC continuing education credits.

LOCATION:  The class will convene at Hamburger University in Room HU 134 (McDonald’s Campus) located at 2715 Jorie Boulevard in Oak Brook, Illinois.  Session time is from 8:30 a.m. to 4:00 p.m.  Dress is business casual. The Hyatt Lodge is offering a refundable rate of $179 per room.  Please log into their website for reservations.

ADVANCE REGISTRATION IS REQUIRED

TUITION MUST ACCOMPANY REGISTRATION

REMIT CHECK OR MONEY ORDER PAYMENT TO:

Illinois Self-Insurers’ Association

20 North Clark Street, Suite 1000

Chicago, IL 60602-4195      

OR

PAY WITH CREDIT CARD:

To register and pay on-line through PayPal, click here