NAICNIPR E-Reg Conference Registration Form May 3-5, 2010

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                        NAIC/NIPR E-Reg Conference Registration Form
                                                                                                                                     Received:
                               May 3-5, 2010 • Kansas City, MO
                                                                                                                                     Check #:
On line registration is now available. Please visit our Web site, www.naic.org/ereg to register online. If you must pay              Amount:
by check, please complete this form.

                                                                REGISTRATION INFORMATION

                                                                                                                                FEE SCHEDULE
 Name:
                                                                                                                                 Non-Regulator Early Bird                $475
 Badge First Name:                                                                                                                        (through 4/6)

 Title:                                                                       ____________________________                       Non-Regulator                           $575
                                                                                                                                 Regulator                               $375
 Company:
                                                                                                                                PRIMARY EXCHANGE REGISTRATION
 Address:                                                                                                                       (mark one please)

 City:                                                    State                           Zip Code:                              Company Licensing
                                                                                                                                 Market Regulation
 Phone:                                                         Fax: ______________________________                              Producer Licensing
 E-mail:                                                          Alt Email                                                      Rate and Form Filing
                                                                                                                                 Technology (TechEx)

                    CANCELLATION POLICY                                                                          CHECK PAYMENT ONLY
 All meeting registration cancellations MUST be in writing to the NAIC          All payments must be in U.S. currency and drawn on a U.S. bank or additional fees will apply. Make
 Meetings Department. Email to meetingsmail@naic.org or fax to 816-             checks payable to NAIC Meetings Department. Please allow 5-7 business days for processing.
 460-7666. Refunds are issued accordingly:                                      Check registration must be received no later than 4/2.
 Cancellation request by 4/6                       $100 Cancel Fee                   NAIC Meetings Department                Overnight     UMB Bank
 Cancellation request after 4/6                          No refund                   PO Box 87-5410                          address:      Attn: Wholesale Lock Box 1st Floor
                                                                                     Kansas City, MO 64187-5410                            Box # 87-5410
 Registration fees are NOT transferable to future meetings, however
                                                                                                                                           1008 Oak Street
 substitutions are accepted. Cancellation refund checks will be processed
                                                                                                                                           Kansas City, MO 64106
 after May 7, 2010.


                                                                    HOUSING INFORMATION

    Reserved room blocks expire 4/9, however rooms may be sold out prior to this deadline. Arrival/departure date changes should be made directly with the hotel, which will
    be subject to a rate increase and availability after the initial reservation. Government IDs are required at check-in to receive the Regulator rate.

    Hyatt Regency Crown Center           2345 McGee Street, Kansas City, MO 64108             Phone: 816-421-1234

    Room reservations can only be made ONLINE using a special NAIC reservations page. Call-in reservations to the hotel will not be accepted. Once registration has been
    completed, you will receive a confirmation via email with a link to register for the hotel.

               Non-Regulator Rate:             $132                         Regulator Rate:      $107



PRE/POST CONFERENCE SESSIONS (you may choose multiple sessions)
Regulator Only                                                                                 Industry Only
 PC-105 I-SITE What’s New Overview, 5/3 @ 8:45 am – 9:45 am                                   PC-110 SERFF 101 – SERFF Basics Tutorial, 5/3 @ 9:30 am – 10:15 am
    PC-115 NIPR State Focus Group, 5/3 @ 10:00 am – 12:00 pm                                  PC-125 Responses 205 – Responses Tutorial, 5/3 @ 10:30 am – 11:15 am
 PC-120 New to the NAIC and Technology Exchange (Tech Ex),                                    PC-160 First-timers NIPR Orientation, 5/3 @ 1:30 pm – 2:15 pm
  5/3 @ 10:00 am – 11:15 am                                                                    PC-175 NIPR Product Demonstrations, 5/3 @ 2:30 pm – 3:15 pm
 PC-130 Objections 205 – Objections Tutorial, 5/3 @ 10:30 am –                                PC-310 SERFF Training for Industry, 5/5 @ 1:00 pm – 4:00 pm
  11:15 am                                                                                      Additional fee of $99 per attendee required with this registration
 PC-145 Student-Teacher Conferences – SERFF State One-on-Ones,
  5/3 @ 1:30 pm – 2:15 pm                                                                      Regulator/Industry
    PC-155 NIPR Regulator Update, 5/3 @ 1:30 pm – 2:15 pm                                     PC-100 SILA Licensing Basics Class, 5/3 @ 8:30 am – 12:30 pm
 PC-170 Regulatory Informational Database Update, 5/3 @ 2:30 pm –                              Additional fee of $85 per attendee to be paid to SILA
  3:15 pm                                                                                      PC-135 SERFF 400 – Cool Tools Tutorial, 5/3 @ 11:30 am – 12:15 pm
 PC-305 SERFF Training for States, 5/5 @ 1:00 pm – 4:00 pm                                    PC-140 PSC Lab – Product Steering Committee Meeting, 5/3 @ 1:30 pm
 PC-400 SBS Education Day, 5/6 @ 9:00 am – 3:00 pm                                             – 3:15 pm
                                                                                               PC-150 Explore the Company Licensing Process, 5/3 @ 1:30 pm – 2:15 pm
                                                                                               PC-165 Evaluation of the Biographical Affidavits, 5/3 @ 2:30 pm – 3:15pm
                                                                                               PC-300 National Treatment and Coordination (E) Working Group Open
                                                                                                Conference Call, 5/5 @ 12:00 pm – 1:30 pm

				
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