23nd Annual
Southern Surety & Fidelity
Claims Conference
(RSVP Form)
April 18th - 20th, 2012
Sheraton Sand Key Resort
Clearwater Beach, FL
Tel: 1-727-595-1611
When making reservations, mention the 2012 Southern Surety Meeting

Please fill in as much information as you can.
You can use your tab key to move between requested information.



Your Full Name
Your E-Mail Address

Your Name ( as you would like it to appear on your name tag )


Company Name
Physical Address
City State Zip

Mailing Address
City State Zip
Phone No.: Fax No.:

CONFERENCE INFORMATION

Please check only those events you will be attending:

WEDNESDAY April 18, 2012

Dinner Wednesday Evening April 18, 2012
Number Attending this event including Yourself.


THURSDAY April 19, 2012

The Conference on Thursday April 19, 2012
Lunch Thursday April 19, 2012

Dinner Thursday Evening April 19, 2012
Number Attending this event including Yourself.


FRIDAY April 20, 2012

The Conference on Friday April 20, 2012
Surety Breakout Session? Fidelity Breakout Session?


Will you be staying: Friday Night? Yes No
Dinner Friday Evening April 20, 2012
Number Attending this event including Yourself.

SATURDAY April 21, 2012


Will you be staying Saturday Night ?Yes No
Dinner Saturday Evening April 21, 2012
Number Attending this event including Yourself.



Would you be interested in any of the following if offered on Friday afternoon after the conference.

Golf Sail Boat Tour Fishing

If So, how many participants?




ADDITIONAL INDIVIDUALS JOINING YOU
For Cockail Parties, Dinners
(Spouse , Significant Other, etc.)

Name (1) Relationship (1)
Name (2) Relationship (2)
Name (3) Relationship (3)

This is a casual dress conference.
This RSVP form is for conference registration only!
Please be sure to call and make your reservations at the hotel before 5:00 PM - March 19, 2012 and don't forget to mention the
Southern Surety Fidelity Claims Conference to ensure reservations at the discounted rate.

Sheraton Sand Key Resort
Clearwater Beach, FL
Tel: 1-727-595-1611
When making reservations, mention the 2012 Southern Surety Meeting

When you Submit this form, you will receive a confirmation form on your web browser
detailing what you have submitted to us. Please print that form as your confirmation.