MWCEA, Inc. 2017 Conference Registration Form

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Attendee Registration

Exhibitors Registration

Sponsorships/Contributions

33^RD ANNUAL
MWCEA CONFERENCE

Ocean City, MD
September 17 - 20, 2017

Thank You to Our 2017
Sponsors!

Join our Sponsors & Contributors >

Tweets by @MWCEA

2017 WORKERS' COMPENSATION CONFERENCE

Program
Highlights

Continuing
Education

Registration
& Payment

Hotel & Other
Information

Conference
Events

Conference
Schedule

Attendee Registration You May Pay by Credit Card or Check Complete and submit this secure, online registration form with your credit card payment, to immediately secure your place at the 2017 Worker's Compensation Conference. You'll also get the chance to sign up for the OC 1K Fun Run / Walk benefiting the Kids' Chance of Maryland, Inc. scholarship fund. Your participation supports the children of the state's seriously injured workers. The run / walk is open to all ages and abilities and will be held Tuesday afternoon, September 19, starting at 2:00 pm on the beach in front of the Clarion Resort. T-shirts are available for anyone donating $20 or more and prizes will be awarded! If mailing a check payment, you must still submit this registration form. An invoice will be automatically emailed to you after submittal. Please mail payment within 5 days of registering online. Include your payment, your Order Number in memo field, and a copy of your emailed invoice. Mail to: MWCEA, Inc. 1701 K Street NW, Suite 650 Washington, DC 20006 ID # 52-1353216
REGISTRATION FEES (Per Person Rates)
	By 8/15/2017	After 8/15/2017
Individual	$225	$275
4 Or More*	$200	$200
Companion**	$150	$200
* 1 to 3 (including Yourself) @ $225.00 each; 4 or More @ $200.00 each Only ONE Companion allowed per registrant. Companions are persons who accompany the registered individual for personal reasons as distinguished from someone with a professional interest in workers' compensation. Companion registration includes social events only. (Companions are not allowed to attend the trade show exhibits or CE sessions and will be issued GUEST Badges that must be worn at all times.) Service fee charges are calculated by credit card companies based on transaction amounts and are not collected by the MWCEA. Print Deadline: All registrations, sponsorships, exhibitor, advertising, contributions and artwork must be postmarked or submitted, and paid, by 8/15/2017 to guarantee placement in the MWCEA Conference Book. - NO REFUNDS -

Please complete as much of the following form as possible.
BUSINESS CONTACT INFORMATION ONLY
Contact information submitted will be printed in Attendee Directory.

(Mandatory information is labeled in red)

First Name (as printed on badge):
Last Name:
Company:
Title:
Industry:
Office Street Address:

Office City:
Office State:
Office Zip Code:
Office Phone:	() -
Office Fax:	() -
Office Email:
Are you an Exhibitor?	Yes No


Please indicate how many people will be registering:
Yourself:	1	@
Additional Registrants: (10 maximum)		@
1 to 3 (including Yourself) @ $225.00 each; 4 or more @ $200.00 each
Companion:		@


Companion's First Name (on badge):
Companion's Last Name:
I understand that the companion registration does NOT include access to the booths, trade show, CE sessions or Lunch & Learn. Access is to Social Events ONLY. Companions will be issued GUEST Badges that must be worn at all times. (Please check box to signify you have read and understand.)

Additional Registrants

	First Name	Last Name	Title	Industry
1.
	Office Phone: ()		Office email:
2.
	Office Phone: ()		Office email:
3.
	Office Phone: ()		Office email:
4.
	Office Phone: ()		Office email:
5.
	Office Phone: ()		Office email:
6.
	Office Phone: ()		Office email:
7.
	Office Phone: ()		Office email:
8.
	Office Phone: ()		Office email:
9.
	Office Phone: ()		Office email:
10.
	Office Phone: ()		Office email:

Yes! Please RSVP me for the Lunch & Learn Session on Monday:	Number Attending
Yes! Please RSVP me for the Lunch & Learn Session on Tuesday:	Number Attending

TOTAL AMOUNT DUE:

Payment Type:

Check Visa MasterCard

Check #:
*Payer Name:**
* e.g. Company, Parent Company or Agency name

Name on Credit Card
(first, last name):

Billing address same as above

Street Address:

City:
State:
Zip Code:

Credit Card Number:

Expiration date:

Month: / Year:

V-code:

There will be a 4% service fee for credit card payments. Service fee charges are calculated by credit card companies based on transaction amounts and are not collected by the MWCEA.

Thank you for using the streamlined and secure online payment process!

Click Here to Complete Your Registration

All discounted registrations must be from the same entity, combined and submitted at the same time.

Workers Compensation professionals - working together for best results!

#MWCEAworks

MWCEA, Inc.
1701 K Street NW, Suite 650
Washington, DC 20006
ID # 52-1353216

Andrea Ball, Executive Director
Phone:	240.206.6007
Fax:	202.449.8560
E-Mail:	info@mwcea.com