R & S CONFERENCE REGISTRATION
AGENCY OR COMPANY
Agency / Company ________________________________________ Contact ’ s Number ________________________________________
Contact Person _________________________ Contact ’ s Email _________________________
Attendee ’ s Name : Attendee ’ s Name Attendee ’ s Name
Full Registration |
�Mem . - $ 225 �Non-Mem . - $ 400 |
�Mem . - $ 225 �Non-Mem . - $ 400 |
�Mem . - $ 225 �Non-Mem . - $ 400 |
Monday Day Pass |
�Mem . - $ 125 �Non-Mem . - $ 225 |
�Mem . - $ 125 �Non-Mem . - $ 225 |
�Mem . - $ 125 �Non-Mem . - $ 225 |
Tuesday Day Pass |
�Mem . - $ 125 �Non-Mem . - $ 225 |
�Mem . - $ 125 �Non-Mem . - $ 225 |
�Mem . - $ 125 �Non-Mem . - $ 225 |
Wednesday Day Pass |
�Mem . - $ 125 �Non-Mem . - $ 225 |
�Mem . - $ 125 �Non-Mem . - $ 225 |
�Mem . - $ 125 �Non-Mem . - $ 225 |
E & O Only |
�Mem . - $ 100 �Non-Mem . - $ 150 |
�Mem . - $ 100 �Non-Mem . - $ 150 |
�Mem . - $ 100 �Non-Mem . - $ 150 |
E & O with Registration |
�Mem . - $ 50 �Non-Mem . - $ 100 |
�Mem . - $ 50 �Non-Mem . - $ 100 |
�Mem . - $ 50 �Non-Mem . - $ 100 |
AFIS Update Only |
�Mem . - $ 100 �Non-Mem . - $ 150 |
�Mem . - $ 100 �Non-Mem . - $ 150 |
�Mem . - $ 100 �Non-Mem . - $ 150 |
AFIS Update with Registration |
�Mem . - $ 50 �Non-Mem . - $ 100 |
�Mem . - $ 50 �Non-Mem . - $ 100 |
�Mem . - $ 50 �Non-Mem . - $ 100 |
Spouse / Guest |
�Mem . - $ 75 �Non-Mem . - $ 125 |
�Mem . - $ 75 �Non-Mem . - $ 125 |
�Mem . - $ 75 �Non-Mem . - $ 125 |
Socials Only |
�Mem . - $ 75 �Non-Mem . - $ 125 |
�Mem . - $ 75 �Non-Mem . - $ 125 |
�Mem . - $ 75 �Non-Mem . - $ 125 |
Amount $ |
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* AFIS UPDATE REGISTRATION Special Farm Property Insurance qualifies as an AFIS Update . If you need to update your designation , please add that registration .
PAYMENT OPTIONS
� Check ( enclosed ) made payable to KAIA
EARLY BIRD SAVINGS
Subtract $ 25 from full conference registration when you register by
APRIL 30
� TOTAL DUE :
HOSPITALITY NIGHT SPONSORS Tuesday night ’ s cornhole tourmanent and hospitality night will be held at District Eat & Play . For all sponsorship opportunites visit kaia . com / events .
$
� Credit Card #_____________________________________ Exp . Date __________ CVV ______ �Visa � MC � Amex Billing Address ____________________________________ City ___________________ State _______ Zip ___________
50
Cancellation / Refund Policy . 90 % of your registration fees may be refunded for cancellations received in writing by May 14 , 2021 . Half of your registration fees may be refunded for cancellations received in writing by May 21 , 2021 . Refunds cannot be issued for cancellations received after May 21 .
Conference Attire . The conference is a business casual event . All after-hours events are casual .
Early Bird Discount . Register by April 30 , 2021 and save $ 25 off each full registration . Simply deduct $ 25 per person when registering by mail or fax .
How to Register : 1 . Mail : KAIA , 815 SW Topeka Blvd ., Topeka , KS 66612 2 . Fax : 785-232-6817 3 . Online : kaia . com / events
QUESTIONS ? CONTACT KAIA ! 800-229-7048 OR INFO @ KAIA . COM
Register & choose your exhibit space at kaia . com / ruralandsmall