Life and Health Compliance Association


95th LHCA Meeting
Wednesday, November 3, 2010
Atlanta, Georgia

If you are currently a member, please Log in to pre-populate your registration form.

Register for this meeting by completing the following:

* = REQUIRED
First Name: *
Last Name: *
E-mail: *
Title: *
Company: *
OR
If your company is not in the list above, enter it below:
Address: *
 
City: *
State: *
Zip: *
Phone: *
Fax:
List Any Industry Designation(s):

Check All That Apply:

This is my first Life and Health Compliance Association Meeting
Plan on bringing a laptop computer and need plug in capability
Member of Handout Committee
Sponsor
Executive Committee

Registration Fee Information:

Registration Fee (postmarked before 10/08/2010): $400.00 $
  Number of Guests: $150.00 per guest $
 
Registration Fee (postmarked after 10/08/2010): $500.00  
  Guest Fee: $200.00 per guest  
Total Registration Fee: $

* Guest fee includes the same breakfast, lunch and reception events provided to the registrant.

Please make registration fee checks payable to "LHCA Fund Account" and mail them to:

LHCA Fund Account
c/o Fred Alvarado
1603 Ivanhoe Ct.
Alexandria, VA 22304

Guest Information:

Name of Guests — list names exactly as you want them to appear on name tag

Guest 1 Name:  
Guest 2 Name:  
Guest 3 Name:  
Guest 4 Name:  

If you are registering more than 4 guests, please provide the names of the additional guest to "e-mail address for the host company"

Special Considerations for Registrant and Guests:
Please list any dietary or physical limitations needing special consideration

Golf Information:

Number of Golfers @ $125.00/per
If necessary, will you have a car available for transportation to the golf course?
If yes, how many golfers could ride with you?
Total Golfing Fee: $

Total Charges:

Total Registration and Golfing Fees: $

Additional Information to be included on attendee lists.
Please mark all that apply:

My company has:
Life Insurance
Variable Life
Equity Indexed Life
Pre-need
Annuities
Variable Annuities
Equity Indexed Annuities
Credit
Health Insurance
Major Medical
Managed Care
Long-Term Care
Medicare Supplement
Disability Income
Specified Disease
Other:


 
 


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