West Bend Mutual Insurance Company

2017 Wisconsin Council Meeting

West Bend Mutual Insurance Company

1900 South 18th Avenue, West Bend, WI 53095

October 20 & 21, 2017

Get Involved…

If it’s going to be, it’s up to me!

Registration Information

Name: ______

Designations: ______

Association Name:______

Email: ______

Address:______

Phone: ______

Employer: ______

Employer Address: ______

Ribbon Information: Please check all that apply –

□Delegate

□Alternate Delegate

□First Timer

□New Member: <12 Months

□Young Professional

Circle C for Current/P for Past

□Local President: C or P

□Regional Officer: C or P

□National Officer: C or P

□Council Director: C or P

□Speaker

□CPIW/CPIM/CIIP

□DAE

Registration Fees

□Registration (Friday and Saturday) / □$65
□Friday Night Social Hour(Included- please indicate if attending)
□Friday Night Welcome Party Painting Class* / □$40
Choose one:
□Presentation: How to Tame Your Gremlin
□CLP Class:How to Make Yourself Indispensable
(Included-Register online and bring your own book)
□Saturday Box Lunch – Qdoba
(Included)
Specify your lunch choice below:
□Adobo-marinated grilled chicken
□Adobo-marinated grilled steak
□Vegetarian
Total Enclosed $______
Make check payable to: WI Council Meeting-KMIP
Mail to:
Sherry Williams, AU, AIS,AINS, CPIW
West Bend Mutual Insurance Company
1900 S. 18th Avenue
West Bend, WI 53095
Registration Deadline: October 6, 2017

Hotel Reservations

Make reservations directly with the hotel:

Make reservations online using the link provided:

Or call the number listed below

Group Name: / Kettle Moraine Insurance Professionals
Group Code: / KMI
Check-in: / 20-OCT-2017
Check-out: / 21-OCT-2017
Hotel Name: / Hampton Inn & Suites West Bend
Hotel Address: / 1975 South 18th Avenue
West Bend, Wisconsin
Phone Number: / 262.305.9740

Room Rates:

2 Queen Non-Smoking Room $102 + tax

1 King Studio Sofa Bed Non-Smoking Room $112 + Tax

Deadline for reservations: October 2, 2017

*Painting class project – Chances will be available to win a

(separate fee applies)beautiful handmade quilt

Dimensions approx. 11”x30”$10/Each or 3/$25

Dimensions approx. 78”x94”