January 24th-26th Rural & Small Agents Conference 2017
Conference Registration
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 Amount q Member - $ 200 q Nonmember - $ 400 q Spouse / Guest - $ 75 q Social Only - $ 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 Social Only - $ 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 Social Only - $ 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 Social Only - $ 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 .
TOTAL DUE :
Method of Payment q Check enclosed made payable to KAIA q Credit Card #______________________________________
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 , 2017 . Half of your registration fees may be refunded for cancellations received in writing by Jan . 20 , 2017 . 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 23 , 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 / events
questions ? Contact morgan in the KAIA office at 800-229-7048 or morgan @ kaia . com Register by Friday , December 23 , to get the best deal on registration fees !