Summit Registration

Contact Information

Name(Required)

First Last

Preferred Name

Title(Required)

Company(Required)

Company Type(Required)

Email(Required)

Primary Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Registering for someone

I am registering on behalf of this person

Your Name(Required)

First Last

Your Email(Required)

Your Primary Phone(Required)

Emergency Contact Information

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Emergency Contact Relationship(Required)

Registration Information

Registration Type(Required)

NAFA Member

Non-Member

The event registration fee is $895 for NAFA members, $1,045 for non-members. Promo codes can be entered on the payment screen.

Contributor Type(Required)

I am a sponsor

I am with a fellow trade association

I am a speaker/moderator

I am a member of the press

None of the above

Has anyone from your company already registered for the event?(Required)

Yes

How many have registered?(Required)

Enter the name(s) of those who have registered.(Required)

Important!

If an error occurs, please note your company has exceeded its maximum number of complimentary passes. Please contact NAFA for details or register as a paying attendee.

Would you like to register any other individuals from your company on this form/transaction?(Required)

Yes

Exclusive pricing is available when registering colleagues from the same company. Discounts will be applied at checkout when registering a second member or more from your organization.

Number of additional NAFA member(s)(Required)

Number of additional non-member(s)(Required)

Additional Member 1

Additional Member 1 Name(Required)

First Last

Additional Member 1 Title(Required)

Additional Member 1 Email(Required)

Additional Member 1 Phone(Required)

Additional Member 2

Additional Member 2 Name(Required)

First Last

Additional Member 2 Title(Required)

Additional Member 2 Email(Required)

Additional Member 2 Phone(Required)

Additional Member 3

Additional Member 3 Name(Required)

First Last

Additional Member 3 Title(Required)

Additional Member 3 Email(Required)

Additional Member 3 Phone(Required)

Additional Member 4

Additional Member 4 Name(Required)

First Last

Additional Member 4 Title(Required)

Additional Member 4 Email(Required)

Additional Member 4 Phone(Required)

Additional Member 5

Additional Member 5 Name(Required)

First Last

Additional Member 5 Title(Required)

Additional Member 5 Email(Required)

Additional Member 5 Phone(Required)

Guest Information

Are you bringing a guest?(Required)

Yes

$200 for non-industry person (spouse, significant other, etc.) to attend all meals and receptions

Guest Name(Required)

First Last

Guest Email(Required)

Guest Phone(Required)

Member Registration Summary

NAFA Member Registration

Price:

Discounted NAFA Member Registration

Price:

Discounted NAFA Member Registration (2+)

Price:

Additional NAFA Member 1

Price:

Discounted Additional NAFA Member 1

Price:

Additional NAFA Member 2

Price:

Additional NAFA Member 3

Price:

Additional NAFA Member 4

Price:

Additional NAFA Member 5

Price:

NAFA Member Guest

Price:

NAFA Member Total Registration Fees

Do you have a promo code?
You will have a chance to enter it in the Payment Information section.

Non-Member Registration Summary

Non-Member Registration

Price:

Additional Non-Member 1

Price:

Additional Non-Member 2

Price:

Additional Non-Member 3

Price:

Additional Non-Member 4

Price:

Additional Non-Member 5

Price:

Non-Member Total Registration Fees

Do you have a promo code?
You will have a chance to enter it in the Payment Information section.

Payment Information

Promo Code

Payment Method(Required)

Check (by mail)

Credit Card

Total Registration Fees

Billing Address(Required)

Same as Contact

Street Address Address Line 2 City State ZIP Code

Credit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Please make checks payable for the above amount to NAFA, and mail within 10 days to:

NAFA, ICO O’Leary & Anick
13400 Bishops Lane, Suite 120
Brookfield, WI 53005

NAFA Annuity Distribution Summit Registration

Contact Information

Emergency Contact Information

Registration Information

Additional Member 1

Additional Member 2

Additional Member 3

Additional Member 4

Additional Member 5

Guest Information

Member Registration Summary

Non-Member Registration Summary

Payment Information