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REGISTRATION FORM
Name:
Title:
Company:
Line(s) of
Business:
Primary job
Responsibility:
Address:
City:    State:    Zip:
Telephone:    Fax:
E-mail:
Payment Method: PayPal Online   Check by Mail   Credit Card by Mail  
First Name
for Badge:
Special accommodations requested: (to remain confidential)
Select Breakout Session #1: E-Commerce and Online Marketing Discussion Group
Property & Casualty Compliance Issues
Selling Insurance and Investments to Seniors
Undecided
Select Breakout Session #2: Advertising Compliance & Social Media
Insurance Hot Topics
State Market Conduct Exams: How to Prepare; How to Respond
Undecided

Select Breakout Session #3: Advertising Compliance & Social Media
State Market Conduct Exams: How to Prepare; How to Respond
Advertising Compliance - Advanced Tools
Undecided

Please list questions you have for the Department of Insurance.
There will be a general question-and-answer session on Friday morning.
List question(s) you would like to submit for discussion.
Please list any other questions you have.
IAdCA places various promotional items with the registration materials for all attendees and, in addition, after the conference is over IAdCA conducts a drawing for various prizes.
Would you or your company like to contribute any items? YES NO

Number of people attending:    
Registration Fees:
  • Before March 20 2010 - $500
  • On or after March 21, 2010 - $550
  • Multiple Registrations Discount: When 2 or more individuals from the same company register, the fee can be reduced $50 per person. Please include all names under "Registering with" on the form. Registrations must be submitted together to receive the reduced rate. Please Note: IAdCA cannot apply the multiple attendee rate for registrations submitted separately from the same company. Please include all names on the remittance check, if paying by check. Please fax or mail multiple registrations together in order to receive the reduced rate.
Cancellation policy:
  • Before March 19, 2010 - Refund.
  • On or after March 22, 2010 - No refund.
For answers to conference questions, contact Murray Vassar, 813-288-7492.






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