Registration Form
for
The Austin C/4 Seminar

La Quinta Inn-Capitol
Austin, Texas

The fee for seminar is $950 for either session. Payment can be made by check to Jim Daniel (payable to Dr. James W. Daniel, ASA, at 4212 Cat Hollow Drive, Austin, TX 78731-2004) or by credit card over a secure connection. 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, FAX (512/343-8788) 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 (at 4212 Cat Hollow Drive, Austin, TX 78731-2004), although later registration is possible if room permits; no refunds after two weeks prior to the start of the seminar session. Queries may be addressed to him by mail at the Cat Hollow address or by phone or FAX at 512/343-8788. Registration is limited; the Seminar may be canceled (with full refund) in the unlikely event that fewer than five registration fees have been received by two weeks prior to the start of the seminar session.

Indicate for which session you are registering:

• 5 – 9 Mar 2010 Fri – Tues in Austin
• 24 – 28 Mar 2010 Wed – Sun in Austin

  Indicate payment method: 
  

  • credit card over a secure connection (date of transaction = ?)
    
  • check to arrive (date to arrive = ?)
  • e-mail guarantee of payment coming from employer  (date of guarantee = ?)
    

   
  Participant's name:

  Home address:

   

  Home phone:

  Business/employer name & address:

   

   

  Work phone and FAX:

  e-mail address:

   

  Registrants must arrange their own housing.