Early Bird Deadline: Prior to May 21, 2014

Hotel: Make your personal reservations directly with LAuberge directly at 866.580.7444, Group code: #SNAIF14
(Hotel Rate is $139/night and the hotel deadline is May 28, 2014).

Registration Form: Please Print or Type
First Name Last Name Nickname for Badge
Designations (Circle) LUTCF CLU ChFC CPCU CFP RHU Other ___________________
Local Association Name ____________________________________________________________________________________
(Circle All that Apply) Regular Member State Officer/Board Member Age 35 & Under
Company and/or Firm ________ Check if this is your first State Convention
Office Address _____________________________________ City, State, ZIP ____________________
Phone (Office or Home) ______________________________
E-mail Address ____________________________________ Facebook user? Yes No
If this is a double registration (NAIFA Member/Spouse or Member/Guest) Yes No
Spouse or Guest Name __________________________________________ Nickname for Badge _________________

Circle all of the following that are current:
AALU NQA MDRT

IFAPAC contributor Level: (please circle):
Annual: Investor Century Club Ambassador Statesman Envoy Diplomat Emissary Capitol

Other Important Details:
Attire: Resort Attire & Business Casual
Continuing Education: 3 Hours of CE pending approval
Hotel Details: Check In Time is 4:00 pm Check Out Time is 11:00 am (Early Check-In cannot be guaranteed)
www.llakecharles.com

2014 NAIFA Louisiana State Convention
June 18-20, 2014 LAuberge Lake Charles
Rejuvenate, Reignite & Raise the Bar


2014 Convention Registration Fees

Registration and Payment Policy: Please send payment with registration form.
Registration will not be processed until payment is received.

Make check or money order payable to NAIFA Louisiana
Mail registration to NAIFA-Louisiana, 5526 Galeria Drive, Baton Rouge, LA 70816

Cancellation Policy: All cancellations must be in writing to the NAIFA-LA office. Cancellations after May 21st will be
charged a processing fee of $50.

Fees include Opening Cocktail Hour, Meetings & Awards Luncheon (Golf & Party By The Pool are not included and separate
fees)


REGISTRATION FEES COST QTY
Double Registration Before May 21 (Member/Guest) $275.00 ___________
Double Registration After May 21 (Member/Guest) $300.00 ___________
Single Registration Before May 21 (Member Only) $175.00 ___________
Single Registration After May 21 (Member Only) $200.00 ___________


MEMBER OPTIONAL EVENTS:
6/18 Golf Outing $75.00 ___________
(Includes green fee and carts)

6/19 Party By the Pool (LAuberge Ticketed Event) purchase thru casino

GRAND TOTAL
Registration Fee and Additional Activities $ ___________

Total Amount Enclosed $ ___________

2014 Convention Questions:
Shannon K. Robertson, CAE, Executive Director
NAIFA Louisiana at 225-293-5258 or
shannonkrobertson@outlook.com