Conference Registration

Name*

First Last

Name on Badge*

Company*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Spouse/Guest Registration

(Not to be used for additional Company representatives)

Name

First Last

Name on Badge

Please Indicate the Number of Attendees for the Below Functions

Wednesday Evening Welcome Reception

Friday Night Dinner

Golf Registration

Player #1 Name

Player #1 Handicap

Player #2 Name

Player #2 Handicap

Please advise if club rentals are needed

Yes
No

Rental clubs paid directly on property

Registration Fees

Registration Fee

REGISTRATION FEES ARE SUBJECT TO A $75.00 LATE FEE AFTER SEPTEMBER 1, 2021 (REFLECTED IN THE RATES, BELOW.) REGISTRATION FEES ARE NON-REFUNDABLE AFTER SEPTEMBER 8, 2021.

Member Fee - $625
Non-Member First Time Attendee Fee - $675
Returning Non-Member Fee - $1,575
N/A Currently registered, adding guest or golf

Spouse/Guest Fee

Member Spouse/Guest Fee - $175
Non-Member Spouse/Guest Fee - $200
N/A

Golf Registration Fee

Thursday, September 23 1:00 at the Mountain Course. In order to secure Tee Times, payment MUST be collected at time of registration.

1 Golfer - $250
2 Golfers - $500
N/A

Total

$0.00

For registration assistance, please call Dawn Bergsma at (941) 330.2221

Comments

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National Alliance of Life Companies An Association of Life and Health Insurance Companies

Register for our Fall 2021 Conference

Spouse/Guest Registration

Please Indicate the Number of Attendees for the Below Functions

Golf Registration

Registration Fees

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