Get Download A Fax/mail Registration Form

This guide provides clear and precise instructions for completing the Download A Fax/mail Registration Form online. Follow these steps to ensure your registration is submitted correctly and efficiently.

Follow the steps to complete your registration form accurately.

1. Click ‘Get Form’ button to access the registration form and open it for completion.
2. Complete the 'Full Name' and 'Preferred Name For Badge' fields with your correct details. This information will be used for identification purposes during the event.
3. Indicate your 'Designations' by selecting the relevant licenses you hold. Options include P&C License, L&H License, CSR, Producer, Owner/Principal, or Other.
4. Provide your 'Agent National Producer Number (NPN)' and 'Date of Birth'. This information helps verify your identity.
5. Select whether this is your first time attending the conference by answering 'Yes' or 'No'.
6. Fill in your payment information. Choose between credit card or check. If paying by credit card, enter the credit card number, expiration date, security code, and billing address. If paying by check, ensure it is made payable to IIANC.
7. Provide your 'Email Address' and 'Phone Number' for contact purposes. This is important for any updates regarding your registration.
8. If applicable, enter the name of your spouse or guest who will be attending with you.
9. Select your 'Registration Type' and specify the total amount to be paid based on the registration fees listed.
10. Include your signature to authorize the payment and confirm the accuracy of the information provided.
11. Review all entries for completeness and accuracy before submitting.
12. Save changes to your document and proceed to download, print, or share the completed form as needed.

Start filling out your registration form online today to secure your spot!