# Registration Form

Of course, all submitted information is kept in the strictest confidence.
You always retain control of your information with D.W. Simpson & Co.
Our services are always at no cost to you.

Name: Address: City: State/Province: Zip Code: Country: Phone: (H) Fax: Phone: (W) (if able to speak freely) Email: Company Name: (optional) Desired Region Other: Professional designations earned: College Student Actuarial Student ACAS FCAS ASA FSA EA CFA MBA MAAA FIA FCIA FIAA Financial Engineer M.S. Ph.D. Data Mining Quant
### Other Designations: | ####
Company Information (optional) Company Name: Address: City: State: Zip Code: Country: Phone: Fax: Email: Please tell us about yourself in the space below: (optional) (Additionally, you may cut and paste your resume here, or email it to D.W. Simpson & Company at actuaries@dwsimpson.com.) When you have finished, simply click the "Submit" button. (It may take a few moments, and you will receive confirmation on your screen.)

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