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!