Request for CPCU Society Representative

Request for CPCU Society Representative

For Conferment Ceremonies, Officer Installations, and I-Days
The purpose of this form is to gather details about your chapter’s upcoming event to assist in securing a CPCU Society representative to attend. Please provide event information to the best of your ability, and allow up to 10 business days for a Society staff member to connect with you.

Once connected with a Society representative, it is the responsibility of the chapter and the Society representative to confirm event logistics and expectations with one another.

Please note: Our Society representatives are available to discuss CPCU Society initiatives, updates, and the value of the CPCU designation and Society membership for local conferment ceremonies and I-Days. Unfortunately, we are unable to accommodate requests for RMI or specific topic-based speaking opportunities. If your chapter is seeking a speaker on a specific topic, we encourage you to post a request on our INteract community to find a suitable speaker.

Thank you for your understanding, and we look forward to collaborating with you for a successful event.
Chapter Name*
Chapter Contact Information
Chapter Contact's Name*

First NameLast Name
Chapter Contact's Email*
example@example.com
Chapter Contact's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Chapter Event Information
Event Date*

MonthDayYear
Date
in-person onlyvirtual onlyhybrid
Event Start Time (according to event location)*

Hour Minutes

AM/PM Option
Event End Time (according to event location)*

Hour Minutes

AM/PM Option
How many people do you expect to have in attendance?*
Chapter officer installationLocal confermentI-DayOther
Have you booked a venue for this event?*
Event Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of venue
Event/Venue Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNoUnsure / Maybe
Name of partner chapter or organization
Speaker / CPCU Society Representative Information
Confer new designeesInstall officersSpeak on behalf of the Society about Society updates and initiatives, value of CPCU Society and/or designation, volunteering with the SocietyOther
YesNo
Name of specific speaker / CPCU Society representative
Yes/AcceptedYes/Unavailable or DeclinedNot Contacted
What are the expectations of the CPCU Society representative?
Please be as specific as possible.
Any additional comments/questions....
Would you like to request a specific CPCU Society representative?
Should be Empty:

Request for CPCU Society Representative

Chapter Contact Information

Chapter Event Information

Speaker / CPCU Society Representative Information