The Intelligent Insurance Solution

Surplus Lines Insurance - In Person

Workers' Compensation Trust
47 Barnes Industrial Park Rd.
Wallingford, CT 06492

Fee: $100.00 per Attendee

(* denotes required fields)

First Name *
Last Name *
Title *
Agency *
Address *
 Address 2
City *
State *
 Zip *
Email *
Phone *
 Fax

(In order to receive your CE credits, please provide your Producer License Information)

National Producer Number:
License(s):



   		Lic. Eff. Date:

Lic. Exp. Date:

Fee: $100.00