Rural & Small Agents Conference 2016
Conference Registration
REGISTER BY DECEMBER 21 AND SAVE!
Agency or Company
Agency/Company _________________________________________ Contact Person ___________________________
Best Phone Number to Contact You __________________________ Email ____________________________________
ATTENDEE(S)
name of attendee
REGistration type
E&O and ETHICS
CHECK MEALS/EVENTS YOU WILL ATTEND
q Member - $200
q Nonmember - $400
q Spouse/Guest - $75
q E&O w/conference - $50
q E&O only - $100
q Ethics only - $50
q Tuesday Social with Exhibitors
q Tuesday Young Agents Social
q Wednesday Lunch with Exhibitors
q Wednesday Hospitality Night & After-Hours
q Member - $200
q Nonmember - $400
q Spouse/Guest - $75
q E&O w/conference - $50
q E&O only - $100
q Ethics only - $50
q Tuesday Social with Exhibitors
q Tuesday Young Agents Social
q Wednesday Lunch with Exhibitors
q Wednesday Hospitality Night & After-Hours
q Member - $200
q Nonmember - $400
q Spouse/Guest - $75
q E&O w/conference - $50
q E&O only - $100
q Ethics only - $50
q Tuesday Social with Exhibitors
q Tuesday Young Agents Social
q Wednesday Lunch with Exhibitors
q Wednesday Hospitality Night & After-Hours
q Member - $200
q Nonmember - $400
q Spouse/Guest - $75
q E&O w/conference - $50
q E&O only - $100
q Ethics only - $50
q Tuesday Social with Exhibitors
q Tuesday Young Agents Social
q Wednesday Lunch with Exhibitors
q Wednesday Hospitality Night & After-Hours
Please note: Spouses and guests must be registered in order to
attend the Trade Show, meals, Hospitality Night and other social events.
Method of Payment
q Check enclosed made payable to KAIA
q Credit Card #______________________________________
Amount
TOTAL DUE:
early bird discount
TAKE $20 OFF EACH REGISTRATION
if you register by Dec. 21. If registering
online, use discount code Early20.
Exp. Date__________ CVV______ q Visa q MC q Amex
Cancellation/Refund Policy. 90% of your
registration fees may be refunded for cancellations
received in writing by Jan. 13, 2016. Half of your
registration fees may be refunded for cancellations
received in writing by Jan. 20, 2016. Refunds cannot
be issued for cancellations received after Jan. 20.
Conference Attire. The conference is a
business casual event. The Young Agent Social,
Hospitality Night and After-Hours events are casual.
Early Bird Discount. Register by December
21, and save $20 off each registration. Simply deduct
$20 per person when registering by mail or fax. To
claim your discount online, enter “Early20” in the
Discount Code field when registering.
How to Register.
Mail: KAIA, 815, SW Topeka Blvd., Topeka, KS 66612
Fax: 785-232-6817
Online: www.kaia.com
|September-October 2015| KANSAS INSURANCE AGENT & BROKER
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