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REGISTRATION FORM
SECTION A… Attendees
If this is your first time to attend a CPPC event, please place an asterisk (*) by your name.
1.____________________________________________
2.____________________________________________
3.____________________________________________
4.____________________________________________
Company: _____________________________________
Address: ______________________________________
______________________________________
Note: Some firms prefer showing a metro area on their name badge. If YOU prefer a specific listing on your badge, please list here: __________________________________________
Email: ________________________________________
Tel: __________________________________________
Workshop Registration Costs… depends upon WHEN your registration PAYMENT is received:
Attendees before 3-1 after 3-1
First person $279 $304
Second person $269 $294
Any additional $259 $284
SECTION B…Guests for reception or other food events:
Guest tickets for a non-registered attendee to attend any meal event is $75 per person. Please provide the names for each person and event attending:
1.____________________ Event: _________________
2.____________________ Event: _________________
3.____________________ Event: _________________
SECTION C…Exhibit Spaces – Limited Availability
Exhibit spaces can be reserved for $175 for a registered attendee or $350 for a non-registered attendee. Spaces are limited and filled on a first come basis. Space includes a table & 2 chairs, unless other requests are specified. Don’t miss out on this great marketing option where attendees come to you.
SECTION D…”QCA” Course – Thursday March 30th
This is a stand-alone course option separate from the CPPC 2023 Workshop. Participation includes course material, lunch and conclusion exam for certification. Cost for the course is $275.00 per person.
Name: _______________________________________
Name: _______________________________________
“Pre-Workshop” Optional Sessions:
“Repair Only” & “Military Round Table”
These sessions are at no additional charge to attendees, but we do need a count for appropriate planning. Please advise if you will be attending one of these sessions.
Attendee Name: _______________ Session: _______
Attendee Name: _______________ Session: _______
Attendee Name: _______________ Session: _______
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SECTION E… Advertising/Sponsorship Information
If you respond by March 17th, we will be happy to include
your name as a sponsor in our “Official Workshop
Program”. Your Black & White Ad options for listings:
Advertising:
Bronze - Business card Ad $50
Silver - Quarter page Ad $100
Gold - Half page Ad $150
Platinum - Full page Ad $250
Sponsorships: (Includes a Half or Full Page Ad)
Program - $1000
Badge Holder - $1000
Reception Entertainment - $1000
Demos, Drinks & Networking - Negotiable *
Reception Decorations - Negotiable *
Optional Sessions - Negotiable *
Breaks & Meals Negotiable *
*: Negotiable amounts can be a combination of Sponsors.
Sponsorship of $500 comes with a half page ad and an
event banner. Sponsorship of $1000 or more comes with
a full-page ad and an event banner. Any donation amount
is accepted, appreciated and will be acknowledged. If we
do NOT receive a special ad from you with your donation,
we will prepare a simple “compliments of” type ad for the
program on your behalf.
Show your support by placing an ad, even if you are
not able to attend this year.
Remember the deadline is 3-17-2023!
(We cannot guarantee your inclusion in the program after
this date.)
Note: Most named Sponsorship opportunities are
available upon request and prices are negotiable.
Contact the CPPC office to discuss.
SECTION F: Optional Lunch Friday March 31st/ $40
each Name(s)__________________________________
TOTALS:
Section A: $___________ Section D: $___________
Section B: $___________ Section E: $___________
Section C: $___________ Section F: $___________
Grand Total: $____________
Payment by check can be mailed to the CPPC address
below along with the registration form.
If paying by CC, an invoice will be emailed to you for
payment through our secure on-line payment portal or
mail the required information to our office for processing.
If choosing this option, please sign here: ___________
If you are not a current CPPC member or have not
previously been a member, we will provide you with a
one-year membership with your registration. Please
initial here if being requested: _____
Refunds for any processed reservations are not
guaranteed and are at the discretion of the CPPC
office.
QUESTIONS? Call the CPPC office at 812-858-0575
email at cppc@claimsnet.org, or by mail at
P.O. Box 1117 Newburgh, IN 47629
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