MAIA Convention Registration Form

Document Sample
MAIA Convention Registration Form Powered By Docstoc
					   Independent
     Agents
                                                                            MAIA’s 19th Annual Convention
                                                                                       February 23-25, 2010
                                                                           Amway Grand Plaza · Grand Rapids




MAIA Convention Registration Form
Instead of filling out this form, register online at http://secure.michagent.org/convention.htm

Please Remember to:          Photocopy this form for additional registrants.
                             Choose which sessions and lunch you’d like to attend on the reverse side.
                             Keep a photocopy of this form (both sides) for your records.
                             Include payment to guarantee your reservation.

Name as it appears on your Producer license

Are you employed with a(n):  Agency  Company  Other (explain)

Nickname (for badge)                                                       Designations

Agency/Company Name

Agency/Company Mailing Address

City/State/Zip

Phone                                                   Fax

Email Address

System ID# (for CE purposes)                                               Last 4 digits of SSN

Spouse’s Name (if attending)


Early Bird Pricing      (expires Friday, January 29, 2010)
Please mark your registration choice(s) below:
                                              MAIA Member       MAIA Member        Non-Member         Non-Member
                                              Early Bird Fee   Fee after Jan. 29   Early Bird Fee   Fee after Jan. 29

 Full Registration – 3 days (includes banquet)     $255            $285               $355               $ 385
 Spouse (meals, including banquet, no seminars)    $115            $145               $245               $ 295
 Tuesday Only                                      $165            $185               $245               $ 295
 Wednesday Only                                    $165            $185               $245               $ 295
 Thursday Only                                     $140            $150               $245               $ 295
 Exhibit Hall and Hospitality Suite Pass           $ 70            $ 70               $ 80               $ 80
 Hospitality Suite Pass Only                       $ 35            $ 35               $ 35               $ 35
 Extra Banquet Tickets Quantity:                   $115            $135               $170               $ 190
Convention Registration Commitment Form
Tuesday, February 23, 2010                                       Wednesday, February 24, 2010
A.M. Sessions (choose one)                                       8:30 a.m. – 11:30 a.m.
                                                                  President’s Forum Followed by Membership Meeting
8:00 a.m. – 11:15 a.m.
 ISO Personal Auto Policy vs. Insurer (Non-ISO)
                                                                  .M.
                                                                 P Sessions (choose one)
    Personal Auto Policies
    Jerry Milton, CIC, Orange Beach, AL                          1:30 p.m. – 4:45 p.m.
    Approved for 3 hours PC Michigan CE credit,                   Ethics in Insurance
    Provider: 0007, Course code: 53036.                              Dave Walker, AAI, CIC, LIC, Hartland Insurance
 Growing Your Agency in Tough Times                                 Agency, Hartland, MI
  Patrick Linnert, Marsh, Berry & Co., Inc., Willoughby, OH          Approved for 3 hours Ethics Michigan CE credit,
  Filed for 3 hours Michigan CE credit.                              Provider: 0007, Course code: 53038

 Legislative Insurance Issues                                    Life Insurance and Annuity Products Trends and
  Scott Hummel, MAIA VP of Government Affairs and                  Considerations
       Dave Evans, Senior VP & Publisher, IA Magazine and          Dave Evans, Senior VP & Publisher, IA Magazine and
       Executive Director, Trusted Choice®, Alexandria, VA         Executive Director, Trusted Choice®, Alexandria, VA
  Filed for 3 hours Michigan CE credit.                            Approved for 3 hours LH Michigan CE credit,
                                                                   Provider: 0007, Course code: 53179.
 None
                                                                  From Personal to Commercial: Get the Competitive
11:30 a.m. – 1:15 p.m.                                             Edge with AAI
 Lunch. Choose one for you and for spouse (if attending):         Presenter Phil Davis, Grand Rapids, MI
                                                                   Approved for 3 hours any line Michigan CE credit,
   Conferment Luncheon       You        Spouse
                                                                   Provider: 0007, Course code: 53034
   No-Frills Box Lunch       You        Spouse
                                                                  None
   No Lunch                  You        Spouse

1:30 p.m. – 4:45 p.m.                                            Thursday, February 25, 2010
 .M.
P Sessions (choose one)
                                                                 8:30 a.m. – 3:30 p.m.
 Who is an Insured?                                              Agency E&O Risk Management
  Jerry Milton, CIC, Orange Beach, AL                                Dave Walker, AAI, CIC, LIC, Hartland Insurance
  Approved for 3 hours PC Michigan CE credit,                        Agency, Hartland, MI
  Provider: 0007, Course code: 53037.                                Approved for 3 hours Ethics, 3 hours any line Michigan
 Agency Perpetuation: Internal vs. Mergers &                        CE credit, Provider: 0007, Course code: 53180
  Acquisitions                                                       Lunch is included.
  Rob Hamilton, Marsh, Berry & Co., Inc.,                            (For Westport/Swiss Re Staff Attendance requirements,
  Grand Rapids, MI                                                   go to http://secure.michagent.org/eo_requirements.htm)
  Filed for 3 hours of Michigan CE credit.
                                                                  None
 Benefits & Pitfalls of Using Social Media at Your Agency
                                               ,
  Jerry Fetty, AIT, CDIA+, CCNA, CCDA, MCP SMART I.T.
  Services, Inc., Sterling Heights, MI and Wayne Joubert,        Cancellation Policy: 50% refund after January 29, 2010.
                         ,
  CAE, AIT, MAIA Sr. VP Communications/IT/Mktg. No CE.           Special Needs: Please notify us of any special needs or
 None                                                           arrangements you may require, (800) 589-5065.
                                                                 Hotel Accommodations: For overnight accommodations,
 President’s Reception & Banquet                                please complete the enclosed hotel registration form and
  (Reception: 5:45 - 6:30 p.m., Banquet: 6:30 - 8:30 p.m.)       return it directly to the Amway Grand Plaza no later than
                                                                 January 29, 2010.



Three easy ways to register ...
1. Complete both sides of form and return with check made payable to: MAIA, PO Box 80620, Lansing, MI 48908-0620
2. Use your credit card and mail or fax to (517) 323-1629  Visa  MC  AMEX  Discover            Exp. Date

   Name on Card                                                  Card Number

3. Register online: http://secure.michagent.org/convention.htm
                                                                                                      Michigan Association
                                                                                                      of Insurance Agents

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:31
posted:3/1/2011
language:English
pages:2