Association of insurance adjusters and associated service providers
Membership Application
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Casino Attendance Application

Member Name:

“Dates” Name:

Contact Email:

Employee’s Names:

Company:

Address:

City & Zip:

Contact Name (Sponsorship):

Telephone Number (Sponsorship):

 

Total Reservations:

1. Members in good standing and their “dates” @ $ 50.00 per person

2. Vendor employees @ $ 65.00 per person

3. Friends and family @ $100.00 per person

4. Payment at the door: @ $125.00 per person (Everybody! -NO EXCEPTIONS)

 

Available Sponsorships: (Information:)

Open Bar @ $500.00 *

Disc Jockey @ $500.00 **

Jackpot Drawing @ $300.00 ***

Banner @ $100.00 ****

Playing Card Raffle @ $150.00 *****

Total $

 

To complete your registration please mail your check no later than November 8, 2013.

Please make your check payable to the West Coast Claims Association and mail it to:
West Coast Claims Association
8307 Temple Terrace Highway
Tampa, Florida 33637

ARMBANDS WILL BE ISSUED AT THE DOOR - DO NOT LOSE YOURS
NO ARMBAND - NO FOOD, NO BOOZE, NO PRIZES

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