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Effective Loss Reserve Opinion Seminar: Tools for the Appointed Actuary November 7 and 8, 2012 • Hilton Baltimore BWI Airport Name (Mr/Ms)1 (Circle One)____________________________________________________________________________________ Badge Name ____________________________________Designations: _______________________________________________ (First or Nickname)

Job Title ___________________________________________________________________________________________________ Employer __________________________________________________________________________________________________ Address ___________________________________________________________________________________________________ City _____________________________________________ State _________ ZIP Code ________________ Telephone ________________________________ E-Mail Address __________________________________ Special Requests o Kosher Meal

o Vegetarian Meal

o Other ____________________________________________________

1. By completing this form, I/we hereby allow any photographs that may be taken of me/us during this event by the American Academy of Actuaries, to be used for any appropriate business purpose.

Lodging at the Host Hotel:

Registration

Hilton Baltimore BWI Airport Special Room Rate: $129 Reservation Deadline: Oct. 15

DATE Please indicate whether you will attend just one or both days. November 7 o November 8 o November 7 and 8 o Fee Category

Early Registration (one day)*

Regular Registration (one day)**

Academy Member

o $450

o $500

o $675

Nonmember

o $650 o Free

o $700

o $775 o Free

Government Actuary

o Free

Early Registration (both days)*

Regular Registration (both days)**

o $725 o $825 o Free

*Early registration will end October 15 at 5 p.m. Eastern. **Attendance is limited, and registration will close on Oct. 31. Late registration may be offered if space allows. To find out if late registration is available, please contact Gabriel Swee at the Academy (swee@ actuary.org, 202-223-8196) between Oct. 24 and Oct 31.

Payment Information o Check payable to the “American Academy of Actuaries” o Mastercard o VISA o AMEX Credit Card Charge Card Number

A full refund will be given for cancellations received by Oct. 31, 2012, but not after. Requests must be made in writing by e-mail or mail to: swee@actuary.org.

________________________________________________

To reserve a room at the Hilton Baltimore BWI Airport, call 410-694-0808. You can also visit http://www.hilton.com/ en/hi/groups/personalized/B/BWIAPHFAAACT-20121105/index.jhtml?WT.mc_ id=POG to make your reservation online. To receive the special $129 room rate for seminar participants, you will need to book your room by Monday, October 15. The Hilton offers all the amenities necessary for total respite, as well as shuttle service to and from BWI Airport.

MAIL THIS FORM TO: Academy Loss Reserve Seminar Attn: Joanne Anderson 1850 M St. NW, Suite 300 Washington, DC 20036

Expiration Date

_________________________________________ Cardholder Name

________________________________________ Signature

Questions? • If you need help with registration, contact Gabriel Swee (202-223-8196, swee@actuary.org).

______________________________________________ • If you have questions about seminar content, contact Lauren Pachman (202-223-8196, pachman@actuary.org) )

PCEffectiveLossOpinionSeminar_2012_MailFax_Form_0  
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