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OCTOBER 18-19, 2023
GREATER RICHMOND CONVENTION CENTER
403 N. 3rd Street, Richmond, VA 23219

Exhibitor Registration

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Preferred Payment Method^*

Pay Offline by Check
Credit Card via Authorize.net

This is for our internal records. You will again need to designate payment method at the bottom of the form.

Business Name

Specialty^*

Please list your service specialty or industry sector here

Contact Person^*

Job Title

Address 1^*

Address 2

City^*

State^*

Zip^*

Email^*

Enter email again^*

Telephone^*

Fax

Conference Exhibitor Fee

Attendee 1 Name

Attendee 1 Title

Attendee 1 Email

Attendee 1 Phone

Attendee 2 Name

Attendee 2 Title

Attendee 2 Email

Attendee 2 Phone

Select Authorize.net to pay by Credit Card now. Select Pay Offline if you will be mailing a check.

When the form is complete, press Submit only once to proceed to the next step. Should you encounter any problems with payment, please call IWCF at (386) 677-0041. PLEASE DO NOT REGISTER A SECOND TIME.

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Pay Offline

Special Needs:
Individuals attending the conference who may need auxiliary aids or special services are requested to provide notice of their needs in writing no later than 10 working days before the conference so that appropriate arrangements can be made .

Lodging:
Conference group rate is $184 per night at the Hilton Downtown Richmond. Reserve the group rate here by September 17th. For questions, call the hotel at 800-HILTONS.

For questions, contact IWCF:
Phone (386) 677-0041
Fax (386) 677-0155
Email: co************@iw**.us

Net proceeds from this event, if any, go to the International Workers’ Compensation Foundation (FEIN# 35-1737364), a non-profit organization, to further its work in workers’ compensation education and outreach.

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For additional information contact the IWCF at:
Phone: 386-677-0041 • Fax: 386-677-0155
Email: co************@iw**.us