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LEAD with Comp Registration - September 2019 Class

Individual Registration Information

Please answer the following questions regarding your registration for LEAD with Comp, in full. If you have any questions regarding the specific questions being asked, please don't hesitate to contact us at agencyrelationstraining@accidentfund.com

Participant's Full Name *This question is required.

Participant's Job Title *This question is required.

Email Address *This question is required. This question requires a valid email address.

Direct Phone Number *This question is required. This question requires a valid number format.

Please indicate the level of your insurance experience *This question is required.

< 1 Year	1-3 Years	3-5 Years	5+ Years
< 1 Year	1-3 Years	3-5 Years	5+ Years

On a scale of 1 to 10 (1=No knowledge, 10=Expert) how would you rate your level of comfort and knowledge on workers' compensation? *This question is required.

No knowledge

Expert

Current Knowledge Level

Which personality test have you taken? *This question is required.

Do you have any dietary needs? (please explain if "Yes")
*This question is required.

Do you need overnight accommodations? *This question is required.