Early Bird Deadline: 

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 Grand Hotel Marriott Resort, Golf Club & SPA at                   , group code: 

(Hotel Rate is $179/night and the hotel deadline is                           ).

Registration Form:  Please Print or Type

____________________________________________________________________________________________

First Name, Last Name, Nickname for Badge

Designations (Circle) LUTCF, CLU, ChFC, CFP, CPCU, FLMI, FSS, RHU, CLF, AMTC, 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 _____

2014 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                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                                                 ___________

Double Registration after                                                     ___________

Single Registration before                                                   ___________

Single Registration after                                                       ___________

NON-MEMBERS:

6/               Golf Tournament (Includes green fee and carts) $50.00 ___________

6/               MDRT/CLU Breakfast Buffet during General Session* $25.00 ___________

GRAND TOTAL                                                         

Registration Fee and Additional Activities $ ___________

Total Amount Enclosed $ ___________

We must have an accurate count for the Tuesday banquet. Please confirm attendance:

____ Yes, # of attendees: _______         ____ Not Attending

Schedule at a Glance

(Subject to change)

Sunday, June 22, 2014

8:00am – 10:30am NAIFA MS 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

Magnolia E-F   ??????

6:00pm – 8:00pm Opening

Welcome Seafood Boil/Jambalaya ?????

Small Craft Harbor

Monday, June 23, 2014

7:30am Exhibits Open

Magnolia E-F ??????

7:45am Registration Continues

8:00am – 8:30am Opening General Session Ceremony

NAIFA-Mississippi and NAIFA-Alabama Presidents Speak

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