Conference Registration Form

Annual Mississippi Workers' Compensation Educational Conference
April 18 - April 20, 2012   Biloxi, MS

The expanded Wednesday afternoon sessions are again returning by popular demand. These optional sessions begin with lunch at 11:45 AM, and from 12:45 to 2:45 PM, two breakout sessions will be offered. The first is a Mississippi workers’ compensation law overview designed for adjusters new to Mississippi, those seeking a refresher course on the details of the law, and other professionals who need the big picture clarified of “how the Mississippi Workers’ Compensation system works”. Running at the same time, a "Multi-State" program will be offered in a fun format designed to contrast and compare the workers' compensation laws of Mississippi, Alabama, Tennessee, Louisiana and Arkansas. From 3PM to 5PM, a panel discussion that includes 4 Administrative Judges and utilization management professionals will take place to discuss issues surrounding the problems with and solutions to Pre-certification and Medical Utilization. The Wednesday afternoon sessions are designed to provide an additional 4 continuing education credits, all for a $40 fee. When combined with the 8 hours from the main conference program, a total of 12 CEU and CLE hours will be available for attendees.

 

 First Name *
  Last Name *    (First Name for Badge)  
 
Job Position *  (if other is selected)  
Company * (as you wish it to appear on name badge)  
 Address *  
   
City *
 State/Province  *  Zip/PostalCode  *    
 
Phone *
(area code + number, no dashes)  Fax (area code + number , no dashes)  
 
Email * Confirm Email*  
CEU Lic.  #    Adjuster Lic.  #   Med/Rehab Lic.  #   Atty Bar  #   
       
Registration *  Please Select Registration Options:
Conference - $225 prior to April 1, 2012 or $275 after April 1, 2012
Guest - $75
     Enter Guest Name (If spouse/companion)
Guests at this fee will not be permitted to attend any training sessions, nor will they be eligible for continuing education credits.
 
 
           ADDITIONAL CEU OPPORTUNITIES
           Wednesday Additional Sessions - $40 includes 2 sessions, lunch and session materials.

           I will attend the sessions I have marked below: (choose only one session for each time frame)       

       
   
12:45 - 2:45  (Option 1)   Mississippi Workers' Compensation Law Overview.   
 
   
12:45 - 2:45  (Option 2)   Contrast and Compare WC laws of  MS, TN, AL, LA, and AR.
 
   
   
 
   
 3:00 - 5:00   Pre-Cert and Utilization Management Problems and Solutions under the 2010
 
   
  Mississippi Workers' Compensation Fee Schedule.
 
       

Credits   CRCC - Commission on Rehabilitation Counselor Certification          (check all that apply - maximum of 3)CCMC - Commission for Case Manager Certification  
    CDMSC - Certification Disability Management Specialist Commission  
    MS CLE - Mississippi Continuing Legal Education  
    LA CLE - Louisiana Continuing Legal Education  
    AL CLE - Alabama Continuing Legal Education  
    CE - Property and Causality as approved by the Mississippi Insurance Dept.   
    MS ACE - Adjuster Continuing Education Credits as approved by the Mississippi Insurance Dept.   
 

    Clicking  submit will process your registration form and take you to the payment page  
  *  Required for Registration