FIFEC Online Registration


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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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