C/4 registration form

Registration Form
for
Jim Daniel's C/4 Seminar



9 - 13 December 2017
Hyatt Place UC Davis
173 Old Davis Road Extension, Davis, CA

The fee for the seminar is $1300. Payment can be made by check to Jim Daniel (payable to Dr. James W. Daniel, ASA, sent to Dr. James W. Daniel, 1515 Shasta Drive, #1516, Davis, CA 95616), or by credit card over a secure connection (processed through PayPal, where you can choose to buy on credit). Since the seminar sometimes fills up, checks should be mailed for next-day delivery; if an employer is paying and needs time to process payment, I'll reserve the slot if a person with financial authority sends me an e-mail or fax guaranteeing payment by the employer. In any case,
please complete this registration form and submit it to Jim Daniel by mail (to Dr. James W. Daniel, 1515 Shasta Drive, #1516, Davis, CA 95616), or e-mail (jimdaniel@actuarialseminars.com) as soon as you arrange payment
and if possible at least two weeks prior to the start of the seminar session, although later registration is possible if room permits; no refunds after two weeks prior to the start of the seminar session (unless the seminar is sold out, there is a waiting list, and a replacement can be found from that list). Queries may be addressed to him by mail at the above address or by e-mail to the above address. Registration is limited; the Seminar may be canceled (with full refund) in the unlikely event that fewer than ten registration fees have been received by two weeks prior to the start of the seminar session.

Indicate payment method: 

 
Participant's name:

Home address:

 

Home phone:

Business/employer name & address:

 

 

Work phone and FAX:

e-mail address:

 

Registrants must arrange their own housing.