Todd McIndoo is a Vice President at Speedy - National Association ...

2010 EA National Conference & Job Fair •2010 National Exclusive Agent ConferenceThe Gaylord National Harbor Resort and Convention CenterNational Harbor, MD – May 5-8Registration FormName: ______________________________________________________________________________________________________First M.I. LastAddress: ____________________________________________City: __________________________ State: ____ Zip: ___________Daytime Ph: ________________ Cell: ________________ Fax: __________________ E-mail: ______________________________Name preferred for conference ID Badge: __________________________________________________________________________Additional Attendee Name(s): ____________________________________________________________________________________Special Meal/Accommodations Request: ___________________________________________________________________________❑ Sign me up for Golf (Spouses or guests welcome)Total Number of players ________Handicap Player #1________ Handicap Guest/Spouse # 1________ Handicap Guest #2 _________Conference Attendees Price x Qty = Extended PriceAgent $149.00 x ___ = _____________Spouse or Non-Agent guest $99.00 x ___ = _____________Golf Tournament $ 149.00 x ___ = _____________Total $____________Method of PaymentTo register online, go to www.napaausa.org and click on the “EVENTS” tab at the top of the page.❑ Check enclosed for the total amount due: $_____________(Payable to NAPAA)Credit Card ❑ VISA ❑ MC ❑ AMEX ❑ DISCName on Account: _____________________________________________________ Amount to charge: $___________________Account Number: _______________________________________________________________ Expiration (mm/yy): _________Billing Address (numerals only) ________________________________________________________ Zip Code______________Authorization Signature: ___________________________________________________________ Security Code______________Fax Registration Form to: (866) 627-2232 orMail to: NAPAA – P O Box 7666, Gulfport, MS 39506Questions?Call toll free: (877) 627-2248Hotel Reservations*Call Gaylord National at 1-301-965-4000, ask for Group Reservation code: “NAPAA 2010”*Deposit required at time of reservation. Cancellations must be made 72 hours prior to arrival date, or forfeit deposit.*Special Group Room Rate $185 + $15 resort fee – Limited number of rooms at this rate – rate expires April 5, 2010.Winter 2009/2010 Exclusivefocus – 39