2012 dca membership form

							                                                                                   Denver
                                                                                   Claims
                                                                                   Association



               Denver Claims Association Membership Application

Dues in the DCA are effective from January
         1st through December 31st                      Membership in the DCA includes automatic
                                                            membership in the Colorado Claims
   Individual Member Cost $45.00 ______                 Association and includes a Colorado Claims
                                                               Association Resource Guide.
   Corporate Member Cost: $150 ______
    Corporate Membership includes up to 4 people



Name(s):                                               Phone Number / Email Addresses:




Company Name:                                          Address:




           denverclaimsassociation.org                 PO BOX 4001, Greenwood Village, CO 80115

           Make checks payable to the
           Denver Claims Association.




                       Lorrie Cisneros ~ President ~ Pinnacol Assurance ~ 303-361-4561
                      Jill Jennings ~ Vice President ~ Private Consultant ~ 303-842-1105
                     Morgan Petterson ~ Treasurer ~ Pinnacol Assurance ~ 303-361-4212
                     Sarah Luciano ~ Program Director ~ Mountain States ~ 720-974-6164