Personal Details

Title:

Forename(s) :

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Surname :

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Company :

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Position :

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Address :

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Post code :

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Country :

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Email :

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Telephone :

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Fax :

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Nature of business :

Accountants Actuary Bank Corporate Risk Manager Consultancy Insurance Broker Industry Association Law Firm Loss Adjuster Ratings Agency Run-off Provider/Buyer Risk Modellers Technology Provider Underwriter Other (Please supply below) *

If 'Other' please provide business type here :

If 'Industry Association' please provide Association name here :

Size of Organisation :

Less than 100 100 - 500 500 - 1000 1000 - 1500 1500 - 2000 2000 + *

Where did you hear about the Insurance Day Summit London Conference?

A link on one of our websites A link from our other websites An e-mail from us An e-mail from a 3rd party At an event Via telephone Via fax Via a colleague Via a search engine Via direct mail An off-line advert/insert Don't know *

If you received a brochure what is the brochure number? (printed on the back page)

*Fee

Complimentary delegates places for Corporate Risk Professionals,**
To apply or nominate someone for a complimentary place please email the Insurance Day Summit London team at corporaterisk@informa.com.

Broking and underwriting companies :
2-Day Summit

If booked by 11th April 2008 £ 895 + VAT @ 17.5%

If booked after 11th April 2008 £ 995 + VAT @ 17.5%

Service providers to the insurance industry :

If you wish to attend the summit please contact Fleurise Luder to apply for a networking pass by emailing fleurise.luder@informa.com or calling +44 (0)20 7017 5360.

I have read and understood the Terms & Conditions listed below

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