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General Meeting - North (June 14)

Public Agency Member
Name of Agency
Name of Attendee
Member: TPA Claim Handler, Supervisor
Name of Member TPA
Name of Attendee
Member: Associates, TPA Non-Claims Staff
Name of Member TPA
Name of Attendee
Non-Member, Late Registration
Name of Member TPA
Name of Attendee

General Meeting - South (June 21)

Public Agency Member
Name of Agency
Name of Attendee
Member: TPA Claim Handler, Supervisor
Name of Member TPA
Name of Attendee
Member: Associates, TPA Non-Claims Staff
Name of Member TPA
Name of Attendee
Non-Member, Late Registration
Name of Member TPA
Name of Attendee

Membership Dues

COSIPA Membership (Select One)
Enter Organization's Name
Associate - Office Location