Early Bird Discount . Register by
How to Register :
Friday, September 17, and save $20 off each
full conference registration. To claim your
discount online, enter “Early20” in the
Discount Code field when registering.
register
by sept. 17
and save!
Mail: KAIA, 815, SW Topeka Blvd.
Topeka, KS 66612
Fax: 785-232-6817
Online: www.kaia.com
Agency/Company _______________________________________________ Contact Person ____________________________
Best Phone Number to Contact You ______________________________ Email ______________________________________
Attendees
name Of attendee
taKe $20 Off eaCH full COnfeRenCe ReGistRatiOn if you register by Sept. 17. If registering online, use discount code Early20
GOlf tOuRnament
e&O Class
YOunG aGent OutinG
tYPe Of ReGistRatiOn
amOunt due
q Member - $185
q Member - $150
q w/Conference - $50 q YA w/Conference
q Nonmember - $285
q Nonmember - $250
q YA ONLY Member - $50
q E&O Only - $100
q Awards Dinner Only - $60
q YA ONLY Nonmember - $100
q Member - $185
q Nonmember - $285
q Awards Dinner Only - $60 q Member - $150
q Nonmember - $250 q w/Conference - $50
q E&O Only - $100 q YA w/Conference
q YA ONLY Member - $50
q YA ONLY Nonmember - $100
q Member - $185
q Nonmember - $285
q Awards Dinner Only - $60 q Member - $150
q Nonmember - $250 q w/Conference - $50
q E&O Only - $100 q YA w/Conference
q YA ONLY Member - $50
q YA ONLY Nonmember - $100
q Member - $185
q Nonmember - $285
q Awards Dinner Only - $60 q Member - $150
q Nonmember - $250 q w/Conference - $50
q E&O Only - $100 q YA w/Conference
q YA ONLY Member - $50
q YA ONLY Nonmember - $100
Guest/Spouse Registration
name Of attendee
tYPe Of ReGistRatiOn
amOunt due
q Awards Dinner Only (Thursday evening) -$60
q Guest/Spouse Full (all meals, no classes) - $100
Golf Tournament Sponsorship
COmPanY name
COmPanY name
tYPe Of sPOnsORsHiP
amOunt due
q Hole Tent (provided by sponsor)- $300
q Tee Sign Only - $250
Young Agent outing Sponsorship
COmPanY name
amOunt due
q $250
q $500
q $1000
tOtal due:
Golf registrations must be received by October 10 method of payment
golf preferRed foursome q Check enclosed made payable to KAIA
Indicate who you wish to be paired with for the Golf Tournament
Name___________________________ Handicap_______
Name___________________________ Handicap_______
Name___________________________ Handicap_______
q Credit Card #______________________________________
Exp. Date__________ CVV______ q Visa q MC q Amex
Billing Address ____________________________________
City__________ State______ Zip______
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: Wednesday, September 12
Group Rate: $99 per night, including breakfast
Cancellation/Refund Policy . 90% of your registration fees may be refunded for cancellations received in writing by Oct. 8. Half of your
registration fees may be refunded for cancellations received in writing by Oct. 12. Refunds cannot be issued for cancellations received after Oct. 12.
quESTIoNS? CoNTACT BARB IN THE KAIA oFFICE AT 800-229-7048 oR [email protected]
18
Register
by Friday,
September
to get the
best
KANSAS INSURANCE
AGENT
& BROKER
| July 17,
- August
2018
|
deal on registration fees!