ConferenceRegistrationForm-02 , -VaccinationSchedule-04, WD2016-Capstone-

Agriculture Insurance Conference Central Sierra Insurance

May 10-12

You are cordially invited to join us for Central Sierra Insurance’s Agriculture Insurance Conference, May 10-12 at Northgate Resort in North Kansas City, Missouri.

Please help us to determine the final attendance count by completing this form for each individual attending from your agency. Complete this form and fax or email ([email protected]) to Asia Pelandale by February 23. Print a copy for your records.

Name: _________________________________________________________________________________

Agency Name: ___________________________________________________________________________

 No, I won’t be able to make it to this year’s Agriculture Insurance Conference.

 Yes, I plan to attend the Agriculture Insurance Conference in Kansas City and will arrive on the following date:

 May 10

 May 11

 May 12

Please reserve the following type of room for me:

 Non-Smoking

 Smoking

 King

 Two Doubles

I will use the following transportation to get to Kansas City:

 Flying—Arrival time: ___________________

 I need a shuttle to Northgate Resort from the airport.

 Driving

 I need directions to Northgate Resort from: _________________________

Arrangements have been made for afternoon golf, for those interested. Please indicate below if you wish to participate in the golf outing. If you do not care to join us for golf, the afternoon is open to do whatever you choose.

 Yes, I would like to participate in the golf outing.

 No, I will not be participating in golf.

If you have any questions about this conference, please feel free to contact either Asia Pelandale or Richard Rhodes. We appreciate your help!

FAX OR EMAIL THIS FORM TO ASIA PELANDALE AT:

FAX: (505-519-8630) or EMAIL: [email protected] SO LU

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