MSPA Live! Registration

Please complete the form below. You may pay by credit card or select an invoice option.

Seating is limited, and can only accommodate 55 people! Currently there are 37 people registered.

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We are sorry, but this event is at capacity and is sold out.

Credentials only Code

Recertification only (For current MSPA holders)

• Recertification only

Check this box if you are attending to recertify your accreditation

First Name and Last Name *

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Last

Credentials

Company

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Address *

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Zip Code

Phone *

Email *

Are you attending the Happy Hour on Monday January 12th?

• Yes
• No

Will you be registering more than 1 person? *

• Yes
• No

How Many Will You Be Registering? (Maximum of 15 per submission)

We’re sorry, you may not register more than 15 people in a single submission. Please reduce that number.

Second Attendee Name *

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Second Attendee Email *

Third Attendee Name *

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Third Attendee Email *

Fourth Attendee Name *

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Fifth Attendee Name *

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Fifth Attendee Email *

Sixth Attendee Name *

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Seventh Attendee Name *

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Seventh Attendee Email *

Eighth Attendee Name *

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Eighth Attendee Email *

Ninth Attendee Name *

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Ninth Attendee Email *

Tenth Attendee Name *

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Tenth Attendee Email *

Eleventh Attendee Name *

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Eleventh Attendee Email *

Twelfth Attendee Name *

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Twelfth Attendee Email *

Thirteenth Attendee Name *

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Thirteenth Attendee Email *

Fourteenth Attendee Name *

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Fourteenth Attendee Email *

Fifteenth Attendee Name *

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Fifteenth Attendee Email *

How would you like to pay? *

• Credit Card
• Invoice

Discount Code

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Once applied, the discount shown will be applied to the Registration price shown below.

Registration Total

Price: $595.00

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Registration is managed by Workers’ Compensation Educational Services, LLC, dba WorkCompCollege.com. Credit card charges will reflect as WCCollege.