!VIVA LA CAPTIVES!

2022 Western Region Captive Insurance Conference
June 27-29, 2022
The Cosmopolitan of Las Vegas, NV

Registration Options*

ATTENDEE INFORMATION

Name (for badge)*

Company*

Job Title*

Email*

Phone Number*

Address*

Please indicate if you have a membership in any WRCIC member association*

N/A
Arizona Captive Insurance Association
Missouri Captive Insurance Association
Nevada Captive Insurance Council
Utah Captive Insurance Association

Please list any special accommodations or dietary needs - ex. vegetarian, gluten free, dairy free, other

Networking Event RSVP

Monday, 6/27 - Welcome Reception
Tuesday, 6/28 - Happy Hour

Tuesday Evening Social Event - Ice Bar

Special Event Registration ($75.00)
Join us for a Drink and Dessert Reception at Minus 5 Ice Bar from 9pm-11pm on Tuesday, June 28.

NOTE: Special Event is included with $200 Networking Pass Registration

Golf Tournament

Golf Registration ($165.00)
The annual Golf Tournament at WRCIC will be held the morning of Monday, June 27 at Bali Hai Golf Club.

Foursome Request (list names of individuals you wish to play with):

If you need to rent clubs, order here:

Right-Handed Clubs ($69.00)
Left-Handed Clubs ($69.00)

Running Total

$0.00

Coupon Code

Total

$0.00

Billing Information

Name*

Payment Method

Credit Card
Pay by Check

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

Email*

Mobile Phone Number*

RegFox Event Registration Software

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