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EVENT CANCELLED
REGISTRATION INFORMATION
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Indicates required field
Name
*
First
Last
Company
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Spouse/Guest Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Select all that apply
Email
*
Phone
*
Registration Options (Check all that apply)
*
$99 - Full Convention - NAIFA Member
$125 - Full Convention - Non-Member
$75 - First Time Attendee (will be verified)
$60 - Spouse/Guest
$40 - Real Life Dinner Only (featuring Bill Rankin Award)
$75 - Golf for 1 (others must register separately)
Notes for Registrar (optional)
*
Total (this amount needed for payment on next page)
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Professional Designation(s) for Nametag
*
CLU
ChFC
CFP
LUTCF
JD
SERIES 6
SERIES 65/66
SERIES 7
CPA
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