Welcome to NAIFA Alabama
"Taking Care of Business"
2013 MS-AL NAIFA State Convention
June 23-25, 2013
Beau Rivage Resort & Casino Biloxi, MS
Early Bird Deadline: Prior to May 22, 2013
Guest Registration: Fee required if guest is 17 or older. Anyone in the insurance business is required to pay the full registration fee.
Hotel: Make your personal reservations directly with Beau Rivage at 888-383-7037, group code: NAIFA MS-AL.
(Hotel Rate is $129/night and the hotel deadline is May 22, 2013).
Registration Form: Please Print or Type
First Name Last Name Nickname for Badge
Designations (Circle) LUTCF CLU ChFC CFP CPCU FLMI FSS RHU Other ______________
Local Association Name ____________________________________________________________________________________
(Circle All that Apply) Regular Member State Officer/Board Member Age 40 & Under
Company and/or Firm
Office Address City, State, ZIP
Phone (Office or Home) E-mail Address
If this is a double registration (NAIFA Member/Spouse or Member/Guest) ___ Yes ___ No
Spouse or Guest Name Nickname for Badge
Name Tags for children _______________________ age __________
______________________________- age _________ ______________________________ age _______________
Circle all of the following that are current:
NAIFA-MS Foundation NQA NSAA NMSA HSQS MDRT
IFAPAC contributor Level: (please circle):
Annual: Investor Century Club Ambassador Statesman Envoy Diplomat Emissary Capitol
Are you on facebook? Yes_____ No _____
____ Check if you need Continuing Education Credits
2013 Convention Registration Fees
Registration and Payment Policy: Please send payment with registration form.
Registration will not be processed until payment is received.
Make check or money order payable to NAIFA MS.
Mail registration to NAIFA-Mississippi, P.O. Box 13649, Jackson, MS 39236
Cancellation Policy: All cancellations must be in writing to the NAIFA-MS office. Cancellations after May 27th will be charged a processing fee of $50.
Fees include – Opening Night Event, Meetings & Banquet (Golf/Breakfasts Event are separate tickets)
• Double Registration includes admission for two to above functions. (NAIFA Member/Spouse or Member/Guest)
• Single Registration includes admission for one to above functions.
REGISTRATION FEES COST QTY
Double Registration before May 22 $215.00 ___________
Double Registration after May 22 $230.00 ___________
Single Registration before May 22 $195.00 ___________
Single Registration after May 22 $210.00 ___________
You must register above and pay the appropriate fee plus $60.00 for the continuing education credits. (Monday and Tuesday)
6/23 Golf Tournament (Includes green fee and carts) $50.00 ___________
6/25 MDRT/CLU Breakfast Buffet during General Session* $25.00 ___________
Registration Fee and Additional Activities $ ___________
Total Amount Enclosed $ ___________
We must have an accurate count for the Tuesday Night banquet. Please confirm attendance:
____ Yes, # of attendees: _______ ____ Not Attending
Schedule at a Glance
(Subject to change)
Sunday, June 23, 2013
8:00am – 10:30am NAIFA MS Board meeting
8:00am – 10:30am NAIFA AL Board meeting
8:00am – 10:00am Exhibitors set up booth
11:00am – 4:30pm Golf Tournament
1:00pm – 5:00pm Registration
10:00am – 5:00pm Exhibitor Move In
6:00pm – 8:00pm Opening
Welcome Seafood Boil/Jambalaya
Small Craft Harbor
Monday, June 24, 2013
7:30am Exhibits Open
7:45am Registration Continues
8:00am – 8:30am Opening General Session Ceremony
NAIFA MS and AL President Speaks
8:30am – 9:30am Julie McNeeley, NAIFA National Secretary
Remit Payment to NAIFA-Mississippi, PO Box 13649, Jackson, MS 39236-3649
Call with questions: (601) 981-1522 or e-mail: NAIFA-Jackson@comcast.net or fax this form to: (601) 981-2745