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2010 Online Registration Form

Please fill out the information below to register ONLINE for this year's FIFEC conference.
Please only use this form if you are paying by credit card.

Registration fees:

Through May 1st $155
After May 1st $175
Walk-in (cash or credit card only) $195

Enter your Name and Title as you would like them to appear on your name badge (no designations, please).

First Name *
Last Name *
Title *
Company/Organization *
Address *
City *
State *
Zip Code *
State of Florida DFS Adjuster #
Phone: *
- -
Ext.
Fax
E-Mail *
Luncheon Attendance (included in registration fee) *
  Yes
  No
Will you be bringing a luncheon guest? *
  Yes
  No
* (An additional charge of $35 for each guest must be added to your registration fee)
Please choose your course selections below:
(You may only select ONE course for each timeslot)
Please list NONE if not attending that session.
Weds PM 1 *
  110 - Ethical Consid. Part 1
  120 - Fraud and Fire
  130 - Preparing for Fraud Trial
  140 - WC Fraud
  150 - Fraud Upon The Court
  160 - Adv. Biomechanical Analysis
  NONE
Weds PM 2 *
  210 - Ethical Consid. Part 2
  220 - Elim. Accidental Fire Causes
  230 - Haitian Culture
  240 - Evidence of Insurance Fraud
  250 - Damage Analysis
  260 - Biomechanics
  NONE
Thurs AM 1 *
  310 - Air Bags
  320 - Compliance Update
  330 - CPT Codes
  340 - Unusual Fire Causes Part 1
  350 - Public Adjuster
  360 - Civil and Criminal Process
  370 - Haitian Culture
  NONE
Thurs AM 2 *
  410 - Car Theft Claims
  420 - Minor Accident Reconstruction
  430 - Device Makers
  440 - Unusual Fire Causes Part 2
  450 - 626 Compliance
  460 - Human Smuggling
  470 - Recent Case Law
  NONE
Thurs PM 1 *
  510 - Fire Loss Claim
  520 - Internet Investigations
  530 - Conditions Precedent
  540 - Civil RICO
  550 - EUO's
  560 - Privacy Rights
  570 - Lightning Repair Claims
  NONE
Thurs PM 2 *
  610 - PIP Law
  620 - Interview of Medical Professional
  630 - Automotive Failures
  640 - Preparing for Fraud Trial
  650 - Compliance Update
  660 - Utilizing Interpreter
  NONE
Fri AM 1 *
  710 - Presentation Skills
  720 - Rehabilitation Coding
  730 - Crime Scene Cleanup
  740 - Handling Excessive Billing
  750 - Check Endorsements for Coverage A
  NONE
Fri AM 2 *
  810 - Fire Origin and Cause
  820 - Surveillance Models
  830 - * CANCELLED *
  840 - Ethics
  NONE
Credit Card Type *
  Visa
  Master Card
  Discover
  American Express
PAYMENT INFORMATION
Credit Card Number (no spaces) *
Exp. Date (Month/Year) *
CSV # *
Please provide your billing address if different from the one above.
Name on card
Billing Address
City/State/Zip
Please type the code shown in the image: *
By clicking submit, you authorize FIFEC to charge your registration fee to your credit card. Fees are non-refundable.
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