REGISTRATION ( Member / Non-Member )
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 . - $ 250 �Non-Mem . - $ 400
�Mem . - $ 175 �Non-Mem . - $ 275
�Mem . - $ 175 �Non-Mem . - $ 275
�Mem . - $ 125 �Non-Mem . - $ 225
�Mem . - $ 100 �Non-Mem . - $ 200
�Mem . - $ 100 �Non-Mem . - $ 200
�Mem . - $ 50 �Non-Mem . - $ 150
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�Mem . - $ 250 �Non-Mem . - $ 400
�Mem . - $ 175 �Non-Mem . - $ 275
�Mem . - $ 175 �Non-Mem . - $ 275
�Mem . - $ 125 �Non-Mem . - $ 225
�Mem . - $ 100 �Non-Mem . - $ 200
�Mem . - $ 100 �Non-Mem . - $ 200
�Mem . - $ 50 �Non-Mem . - $ 150
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�Mem . - $ 250 �Non-Mem . - $ 400
�Mem . - $ 175 �Non-Mem . - $ 275
�Mem . - $ 175 �Non-Mem . - $ 275
�Mem . - $ 125 �Non-Mem . - $ 225
�Mem . - $ 100 �Non-Mem . - $ 200
�Mem . - $ 100 �Non-Mem . - $ 200
�Mem . - $ 50 �Non-Mem . - $ 150
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Monday Day Pass |
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Tuesday Day Pass |
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Wednesday Day Pass |
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Spouse / Guest |
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Socials Only |
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Tuesday Lunch Only |
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Amount $ |
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EARLY BIRD SAVINGS Subtract $ 25 from full conference registration
when you register by Dec . 19 .
� TOTAL DUE : $
PAYMENT OPTIONS � Check ( enclosed ) made payable to KAIA
� Credit Card #_____________________________________ Exp . Date __________ CVV ______ �Visa � MC � Amex Billing Address ____________________________________ City ___________________ State _______ Zip ___________
Cancellation / Refund Policy . Requests received within 30 days or more of the event , will receive a 50 % refund . No refund will be issued for any cancellation requests on or after January 16 , 2023 . Any approved refunds in full regardless of reason will be subject to a $ 30 processing fee . No refunds will be processed for “ no shows ”. Any other requests for cancellation beyond these guidelines will be assessed by KAIA and a refund will be granted on a case-by-case basis . All cancellations / changes must be made in writing .
Conference Attire . The conference is a business casual event . All after-hours events are casual . Send More , Save More : Send 3 + agents from one agency , save $ 10 per registration ( on top of EB discount )
How to Register :
1 . Mail : KAIA , 815 SW Topeka Blvd ., Topeka , KS 66612 2 . Email : info @ kaia . com 3 . Online : kaia . com / events or scan QR Code :
QUESTIONS ? CONTACT KAIA !
800-229-7048 OR INFO @ KAIA . COM
KAIA . com | Register Today !