NAFA Annuity Leadership Forum Registration

Complete the form below to register for this exceptional event, to be held in person in our nation’s capital. You can also confirm your plans to participate in our Hill Walk during the event. A confirmation will be sent to the email address provided during registration.

Step 1 of 12 - Your Information

Contact Information

Name(Required)

First Last

Title(Required)

Company(Required)

Email(Required)

Primary Phone(Required)

Mobile 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 Title(Required)

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 $795 for NAFA members and $995 for non-members. Promo codes can be entered on the payment screen.

Organization Type(Required)

Agent/Advisor

Insurance Carrier

Marketing Organization (IMO/FMO)

Industry Association Member

Vendor

Sponsor

Will you attend our Hill Walk?(Required)

Yes

The Hill Walk is currently scheduled for Tuesday, June 25. A home address is required to ensure you are able to attend meetings with your respective Senators and Representative.

Home Address(Required)

Same as Contact Address

Street Address Address Line 2 City State ZIP Code

Has anyone from your company already registered? (Excluding those registered with complimentary/sponsorship passes)(Required)

Yes

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 for any additional individuals from your company?(Required)

Yes

Exclusive pricing is available for NAFA members registering colleagues from the same company. Register additional members of your organization and receive $100 off for each of those members.

Number of additional members(Required)

Number of additional non-members(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)

Will Member 1 attend the Hill Walk?(Required)

Yes

Member 1 Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Hill Walk packets will be mailed to Member 1's home address.

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)

Will Member 2 attend the Hill Walk?(Required)

Yes

Member 2 Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Hill Walk packets will be mailed to Member 2's home address.

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)

Will Member 3 attend the Hill Walk?(Required)

Yes

Member 3 Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Hill Walk packets will be mailed to Member 3's home address.

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)

Will Member 4 attend the Hill Walk?(Required)

Yes

Member 4 Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Hill Walk packets will be mailed to Member 4's home address.

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)

Will Member 5 attend the Hill Walk?(Required)

Yes

Member 5 Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Hill Walk packets will be mailed to Member 5's home address.

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)

NAFA Member Registration Summary

Individual Member Registration

Price:

Discounted Member Registration

Price:

Additional Member 1

Price:

Additional Member 2

Price:

Additional Member 3

Price:

Additional Member 4

Price:

Additional Member 5

Price:

Guest

Price:

Total Member 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

Individual 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:

Total Non-Member 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