LHCA: Registration

Register for the 90th LHCA Meeting by completing the following:

Click here to submit a question for the meeting.

* = REQUIRED

First Name: *

Last Name: *

Title: *

Company: *

Address: *

City: *

State: *

Zip: *

Phone: *

Fax:

E-mail: *

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 after 08/08/2008):	$425.00
	Number of Guests:	$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 "Wolters Kluwer Financial Services" and mail them to:

Pamela Ewing
Director of Product Management
Wolters Kluwer Financial Services
130 Turner Street
Bldg. 3, 4th Floor
Waltham, MA 02453

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 @ $75/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: