Early Bird Discount. Register by Friday, September 23, and save $20
off each registration. To claim your discount online, enter “Early20” in the
Discount Code field when registering.
register
by sept. 23
and save!
How to Register.
Mail: KAIA, 815, SW Topeka Blvd., Topeka, Kansas 66612
Fax: 785-232-6817
Online: www.kaia.com
Agency/company
Agency/Company _______________________________________________ Contact Person ____________________________
Best Phone Number to Contact You ______________________________ Email ______________________________________
Attendees
TAKE $20 OFF EACH REGISTRATION if you register by Sept. 23. If registering online, use discount code Early20
name of attendee
TYPE OF REGistration
Golf tournament
E&O CLASS
meals attending
q Member - $185
q Awards Dinner Only - $60
q Nonmember - $285
q Member - $130
q Nonmember - $250
q w/Conference - $50
q E&O Only - $100
q 10/6 Lunch Panel
q 10/9 Awards Dinner
q 10/7 Eggs & Issues
q Member - $185
q Awards Dinner Only - $60
q Nonmember - $285
q Member - $130
q Nonmember - $250
q w/Conference - $50
q E&O Only - $100
q 10/6 Lunch Panel
q 10/6 Awards Dinner
q 10/7 Eggs & Issues
q Member - $185
q Awards Dinner Only - $60
q Nonmember - $285
q Member - $130
q Nonmember - $250
q w/Conference - $50
q E&O Only - $100
q 10/6 Lunch Panel
q 10/6 Awards Dinner
q 10/7 Eggs & Issues
q Member - $185
q Awards Dinner Only - $60
q Nonmember - $285
q Member - $130
q Nonmember - $250
q w/Conference - $50
q E&O Only - $100
q 10/6 Lunch Panel
q 10/6 Awards Dinner
q 10/7 Eggs & Issues
TOTAL DUE:
Golf registrations must be received by September 26
Indicate your preferred foursome below
golf preferRed foursome
Indicate who you wish to be paired with for the Golf Tournament
Name___________________________ Handicap_______
Name___________________________ Handicap_______
Name___________________________ Handicap_______
Amount dUE
method of payment
q Check enclosed made payable to KAIA
q Credit Card #______________________________________
Exp. Date__________ CVV______ q Visa q MC q Amex
hotel
reservations-Bluemont
1-785-473-7091, $99.00 per night
Reservation Line: 1-785-473-7091
Address: 1212 Bluemont. Ave, Manhattan, KS
Group Code: KAIA
Deadline: Friday, September 16
Group Rate: $99 per night, including breakfast
Cancellation/Refund Policy. 90% of your registration fees may be refunded for cancellations received in writing by Sept. 25. Half of your
registration fees may be refunded for cancellations received in writing by Sept. 30. Refunds cannot be issued for cancellations received after Sept. 30.
26
questions? Contact joan in the KAIA office at 800-229-7048 or [email protected]
KANSAS INSURANCE
AGENT
& BROKER
|JULY
Register
by Friday,
September
23,- AUGUST
to get the2016|
best deal
on registration fees!