Page 1 of 5

Catastrophe: The Coverage Expertise You’ll Need When It Matters - 9/6/18
  1. You are registering for the following Event or Class:

    Catastrophe: The Coverage Expertise You’ll Need When It Matters – Live Webinar
    September 6, 2018
    8:00 a.m. – 11:00 a.m. (CST)

    Online registration is only available with credit card payment. Pre-payment is required. Registration without payment will not be processed.
    PIAW now accepts the following major credit cards:
    mastercard 48visa 48amex 48discover 48
    Payments are securely processed through Payment Service Network.
  1. Please enter your information below.
  2. (*Required)

    Invalid Input
  3. First Name(*Required)
    Please tell us your first name.
  4. Last Name(*Required)
    Please tell us your last name.
  5. Date of Birth (MM/DD/YYYY)(*Required)
    Invalid Input
  6. NPN# (Please enter N/A if you are not licensed)(*Required)
    Invalid Input
  7. Designations
    Invalid Input
  1. Agency, Company, or please enter N/A(*Required)
    Please tell us your Company or Agency name.
  2. Address(*Required)
    Please tell us your address.
  3. City(*Required)
    Please tell us your city.
  4. State(*Required)
    Please tell us your state.
  5. Zip Code(*Required)
    Please enter a valid zip code.
  6. Phone(*Required)
    Please enter a valid phone number
    xxx-xxx-xxxx
  7. Cell Phone
    Please enter a valid phone number
    xxx-xxx-xxxx
  8. Fax Number
    Please enter a valid fax number.
    xxx-xxx-xxxx
  9. Email(*Required)
    Please enter a valid email address.
  1. By clicking here, you understand and agree to our terms and conditions.(*Required)

    Please check to verify that you have read and agree to the terms listed.
  2. Event
    Invalid Input
  1. Amount Due
    Invalid Input
  2. If the Amount Due box is empty, please use the "PREV" buttons to navigate back and select your membership status. If this is not done, you will receive an error when trying to process your payment.
  3. Please enter your payment information below.

    PIAW now accepts the following major credit cards:
    mastercard 48visa 48amex 48discover 48
    Payments are securely processed through Payment Service Network.
  4. Credit Card Number(*Required)
    Please enter a valid Credit Card Number
  5. Credit Card Expiration(*Required)
    Please enter your Expiration date as MMYY
    MUST BE IN THE FORMAT MMYY (no spaces or / )
  6. CC Billing Address Zip Code(*Required)
    Please enter a valid zip code.
  7. WARNING: It may take a few moments to process your payment. Clicking "submit" more than once may result in multiple charges to your credit card. If you are not redirected after submitting your payment, please call the PIAW at 608-274-8188
    Your confirmation will be emailed within 24 hours.

Featured Benefit: PIAW INS Programs

PIAW INS5

PIA Large

Professional Insurance Agents of Wisconsin
6401 Odana Road | Madison, WI 53719
Phone: (608) 274-8188 | Toll Free (800) 261-7429
Fax: (608) 274-8195 | Toll Free (866) 203-7461

pia-national-news