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Insurance Professionals of Monterey Bay Presents:
31st Annual California Council Meeting October 27th – 28th, 2017
Mail in Registration Form
Attendee Information: First Name: __________________________________________ Last Name: _______________________________________
Mailing Address: _____________________________________________________________________ Apt/Suite: _____________
City: _________________________________________________________ State: _____ Zip Code: ____________
Email Address: _________________________________________________________________________________________________
Local Association: _________________________________________________________________________________________________
Designations: _________________________________________________________________________________________________
Daytime Phone: _________________________ Employer: _________________________________________________________
Ribbon Information: ___ Delegate ___ CIIP/CPIW/CPIM ___ Past National Officer ___ Alternate (Circle One Please) ___ Past Regional Vice President ___ First Time Attendee ___ DAE ___ Past State Council Director ___ Gold Timer ___ CLP ___ Current RVP ___ CWC Contestant ___ Speaker ___ Current State Council Director ___ Local President ___ Exhibitor
Registration:
Early Bird Registration (expires 09/05/17) ___ $125.00 $__________ Registration (after 09/05/17) ___ $145.00 $__________ Non-Member Registration ___ $150.00 $__________
Education: ___ Ethics (3 hours CE) ___ No Charge ___ Flood- ‘Just the Facts’ (3 hours CE) ___ No Charge ___ CLP ‘Financial Intelligence’ ___ Download (IAIP) & bring to class
($20 Student Guide, download from IAIP website and bring to class)
___ “Marijuana – Impact on PC and W/C” ___ No Charge
Events: Friday Night Welcome Cocktail Reception (Extra Ticket Only) ___ $20.00 $__________
Saturday Luncheon & Silent Auction (Extra Ticket Only) ___ $35.00 $__________
Saturday Awards Dinner & Halloween Party (Extra Ticket Only) ___ $55.00 $__________
Exhibitor/Fundraiser Registration (Friday October 27, 2017) ___ $25.00/Table $__________ *Set up begins at 8:00 AM – must be broken down by 4:00 PM TOTAL DUE: $__________ (Registration + Additional Tickets) How To Register:
Make check payable to: Insurance Professionals of Monterey Bay Mail to: IPMB 2017 Council Meeting C/O Robin Fawkes, SMCSIG 1791 Broadway Redwood City CA 94063 PAYPAL: http://ipmbofnaiw.weebly.com/
REFUND POLICY: NO REFUNDS OR CANCELLATIONS AFTER 10/16/17. CANCELLATION REQUESTS MUST BE IN WRITING.