InsuranceIndustryLegislativeConference-NAIFAIllinois.docVIP

Insurance Industry Legislative Day Tuesday, March 29, 2011 Prairie Capital Convention Center, Springfield Hosted By: NAIFA Illinois Independent Insurance Agents of Illinois (IIA of IL) Illinois Insurance Association (IIA) IL State Association of Health Underwriters (ISAHU) IL Association of Mutual Insurance Companies (IAMIC) Financial Planning Association of Illinois (FPA of IL)  Tentative Schedule of Events:  10:30 A.M. Registration 10:45 A.M. First Time Attendee Orientation 11:30 A.M. Lunch and Introductions  1:30 P.M. Break Out Sessions 2:30 P.M. Capitol Visits (Transportation Provided) 5:00 -7:30 P.M. Legislative Reception (IL State Library)  Please use one form per participant, form may be duplicated. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Member of ? NAIFA IL ? IIA of IL (PIIAI) ? IIA ?ISAHU ?IAMIC ? FPA Name: Company: Address: (Street, P.O. Box) (City) (ZIP) Phone: Email Address: Home Zip + 4: (Or home address. This information will only be used to determine your legislative district for event planning purposes.) Early Registration Fee (Before March 1st) $ 35.00 Regular Registration Fee (March 1st and later) $ 45.00 Non-member $ 55.00Non-member Guest (To attend reception only) $ 20.00 TOTAL ENCLOSED: _______________________ Payment Options: ? Visa ? Master Card ? American Express ? Check Name on Card:________________________# Exp. Date Remit registration form and payment to: IIA of Illinois, P.O. Box 3352, Springfield, IL 62708-3352 or FAX to: (217) 793-6744 No refunds after March 1st, 2011 Visit  HYPERLINK http://www.InsuranceLegislativeD www.InsuranceLegislativeD for hotel details, legislator contact i