th Annual Educ ation Se 0 5 s ’ M min ar IIAN Registration Form
15 Hours of Continuing Education for the Insurance Professional
Non-Member
Member
$240 $140 $75 $45
$200 $105 $70 $35
Entire Seminar One Full Day One Half Day Ethics Only
Includes: Two Full Days One Full Day Four Hours Three Hours Ethics Only -
Ethics (15 hours of NM CE) Ethics (8 hours of NM CE) AM Class / PM Class - Ethics included after PM session (1 hour - either day)
Select a morning and afternoon class for both days of instruction to receive your full fifteen hours of continuing education. If you have any questions regarding the registration process, call Jeff Straight at (505) 999-5802 or (800) 621-3978.
Wednesday - March 10, 2010
Thursday - March 11, 2010
AM Course :
AM Course :
PM Course :
PM Course : Lunch is on your own
Ethics
Lunch is on your own
Ethics
Please note: The room temperature may vary, please bring a sweater
Method of Payment
Full Name:
(Please note that full payment must be received with Registration Form in order to secure class reservation)
First Name for Badge:
Bill Our Agency (For Members Only) Check Enclosed (Payable to IIANM) Charge my credit card (VS, MC, AMEX, DISC):
Agency / Company: Address:
*All fees include sales tax.
City, State, Zip: Telephone: Fax:
(
(
Amount: $ ___________ (all prices include sales tax) Card No.: _____________________________________
)
Exp. Date: ______________
)
Authorized Signature:
E-Mail: Please Return this Registration Form and Payment to:
IIANM, 1511 University Blvd. NE, Albuquerque, NM 87102 - Fax (505) 243-3367 or email back to jeff@iianm.org Seminar Location & Accommodations:
The Albuquerque Hilton 1901 University Blvd. NE Albuquerque, NM 87102 Phone (505) 884-2500 or (800) 274-6835
Group Name: Group Rate: Hotel Cut-off:
Independent Insurance Agents of New Mexico (IIANM) $100 - single / double February 9, 2010
Check-in time is 3:00pm, check-out time is 12:00 noon.
KNOWLEDGE IS GOLD