Begin Registration

What type of attendee are you?

Member

Non-Member

Member - Underwriter, Claims Specialist

Non-Member - Underwriter, Claims Specialist

Emeritus / Retired

Attendee Info

Salutation

*First name

*Last name

*Email address

*Phone number

*Company / Organization name

*Work address

*City

*Country

*Province / Territory

*Postal code

*Professional title / Position

Credentials

Please enter your first name ONLY, exactly as it will appear on your name badge

Please indicate any dietary, mobility, or other special requirements

*Emergency contact (name and phone number)

Do you give permission for your name, company/organization, city, and province to appear on the list of participants that CLIMOA shares with delegates and sponsors?

Yes

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