TASCnet
c/o Chris Gory
Insurance Portfolio Inc.
10 Milner Business Court, Suite 800
Toronto, ON
M1B 3C6

Registration Form
for Members of the
ASCnet local chapters
ASCnet member     $275.00 ASC user group:
Non-member          $350.00
Brokerage:
Address:
Address:
City:
Province:
Postal Code:
Phone Number: ###-###-####
Contact :
Email:
TAM version:
Participant's Name: Email Position: Amount
Total

Please make cheques payable to: TASCnet

Please mail cheques to:
TASCnet
c/o Chris Gory
Insurance Portfolio Inc.
10 Milner Business Court, Suite 800
Toronto, ON
M1B 3C6

NOTE: If you receive an error and cannot complete the registration form on-line, please print a copy and fax to 416-754-3914. We will confirm your registration by return email.