/ The Dairyland CPCU Society Chapter
CPCU and IIA class information and registration form
Preparation for the testing window
April 15 – June15, 2017

REGISTRATION DEADLINE:

A $10 late charge will be added for registrations received after the registration deadline of
January 20th, 2017

DAIRYLAND CPCU SOCIETY CHAPTER SPRING 2017CLASS SCHEDULE

Please note: The ending date of these classes varies (i.e. earlyto mid-May) as they have different amounts of material to cover and some instructors will offer review sessions. The instructor will let you know the first night of class what the date of the last class will be.

CPCU 500-Foundations of Risk Management and Insurance
Instructor / Class Location / Day / Time / Starts
John Roble, CPCU / American Family Insurance 6000 American Pkwy
Building A-Ed Center, Rm A2142
Madison, WI 53783 / Thursdays / 5:15-6:45pm / 2/16/2017
CPCU 520-Insurance Operations
Instructor / Class Location / Day / Time / Starts
Kendra Whipple, CPCU / American Family Insurance 6000 American PkwyBuilding A-Ed Center, Rm A3142
Madison WI 53783 / Wednesdays / 5:15-6:45pm / 2/15/2017
AINS 22-Personal Insurance
Instructor / Class Location / Day / Time / Starts
Terry Meyer, API, AU / American Family Insurance 6000 American Pkwy
Building A-Ed Center, Rm A3142
Madison, WI 53783 / Tuesdays / 5:15-6:45pm / 2/7/17

For course descriptions/information about the CPCU designation visit:

Forinstructor biographies visit:

CPCU/IIA CLASS REGISTRATION FORM
Dairyland CPCU Society Chapter SPRING 2017

Name:

Mailing Address:

City, State, Zip:

Employer:

Telephone: BusinessHome

Fax:E-mail:

I am registering for the following:

Course name:

Enclosed/attached is check for $*

Class Tuition* – $200 per student for the AINS and $250 per student for CPCU classes

ADDITIONAL $10 ADDED AFTER DEADLINE

Deadline: January 20th, 2017

*Books and exam registration fees are not included in class tuition.

BOOK ORDERS & EXAM REGISTRATION: Students must order the books and register for the national exam by contacting the Institutes at 800-644-2101 or online at . Please allow 7-10 days for ordering your books.

To enroll**, print this completed form & return it with your check payable to ‘Dairyland CPCU Society Chapter’ to:

Julia Bonfiglio, CPCU

N4151 Oakhill Circle

Brodhead, WI 53520

**Please also scan and email your registration form toto hold a spot on the roster for you in the class.

LATE REGISTRATION FEES & CANCELLATION GUIDELINES

  • Enrollments received after the class begins will be charged a $10.00 late fee.
  • If the class is full, the full tuition amount will be refunded.
  • If you cancel/drop the class during the 1st or 2nd week of the class start date, you will receive a $150 credit.
  • If you cancel/drop the class during or after the 3rd week of the class start date, you will not receive a credit.

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December 22, 2016