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106TH ANNUAL CONVENTION REGISTRATION

RESERVE YOUR SPOT

Company

First name

Last name

Phone

Street Address

City

Region/State/Province

Postal / Zip code

Are you bringing a guest? (Guests and children must be paid for separately)

Guest First and Last Name

Attendee and Guest T-shirt Sizes (t-shirts sponsored by Brainard Rivet)

Children (Age 10 and Under - will only pay for what they attend)

Children (Age 11-17 - will only pay for what they attend)

Dinner Selection

Guest Function Attendance

Thursday, October 5th - Registration & President's Reception

Pickup registration materials, Osprey Foyer 3 - 5PM

President's Welcome Reception, Indigo Rooftop 6:30 - 8PM

No, I will not be attending

Friday, October 6th - General Speaker Sessions

Osprey Ballroom 8AM - 3PM

Board Meeting, Avocet Boardroom 3 - 4PM * Board Members Only

No, I will not be attending

Friday, October 6th - Laser Skeet Shooting Happy Hour, Croquet Lawn North

5PM - 7PM

No, I will not be attending

Saturday, October 7th - Bryan Taylor Memorial Golf Tournament, Links Course, 8 AM

Yes, I will be attending

No, I will not be attending

Player 1 First and Last Name

Player 1 Rental Clubs

Player 1 Email

Player 2 First and Last Name

Player 2 Rental Clubs

Player 2 Email

Saturday, October 7th - Dinner, Golf Awards & Entertainment

Reception, Osprey Outdoor Terrace 6 - 7PM

Dinner & Entertainment, Osprey Ballroom 7 - 11PM

No, I will not be attending

Sunday, October 8th - Departing Breakfast, Osprey Outdoor Terrace 8 AM

Yes, I will be attending

No, I will not be attending

Assumption of Risk

I understand that ACIA cannot prevent me from becoming exposed to, contracting, or spreading COVID-19 while attending the Convention and/or events. I understand that by choosing to attend, I may be exposing myself to and/or increasing my risk of contracting or spreading COVID-19.

Registration Completion

Please select one payment option

Credit Card (if choosing this payment option, you MUST complete payment below for each individual registered)

Request invoice (to pay by check, mail to ACIA, 2620 Bardstown Rd, Suite 7, Louisville, KY 40205)

Select Items for your Conference Attendance (if paying by credit card, you MUST complete payment below)

Member Convention Registration - $800.00

Guest Convention Registration - $800.00

Golf Tournament Registration - $200.00

Golf Club Rentals - $78.00

Thank you for your registration! If you chose to pay via credit card, please complete your credit card transaction by clicking on your selections below. Your completed registration form must be accompanied with payment in order to be fully registered for the convention. If an invoice has been requested,

it will be sent via email for payment.