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2017 Annual Conference

REGISTRATION FORM

OCTOBER 23-26, 2017 • EAU PALM BEACH RESORT, MANALAPAN, FLORIDA

 

1. Registrant & Spouse/Guest Information

Registrant
First Name*
Last Name*
Company*
Address*
Address 2
City
State/Province
Postal Code
Country
Phone* ( ) -
Email*
Preferred First Name on Badge*  
Spouse/Guest
Additional attendees from the same company are not considered guests.
First Name
Last Name
City
State/Province
Preferred First Name on Badge
Additional Guest
First Name
Last Name
City
State/Province
Preferred First Name on Badge
Arrival and Departure Dates

The Conference begins Monday, October 23rd and runs through Thursday, October 26th
Arrival Date*
Departure Date*
2. Registration Fees
Full refund of the registration fee will be made if notice of cancellation is received by September 15, 2017. One-half of the fee will be refunded if requested by October 6, 2017. After October 6, 2017, no refunds will be made.
STA Member Only @ $625.00 ea
STA Member with Spouse/Guest @ $775.00 ea
Non STA Member @ $775.00 ea
Non STA Member with Spouse/Guest @ $925.00 ea
Additional Guest @ $150.00 ea
STA Honorary Member @ $0.00 ea
3. Sponsorship Contribution
If you do not with to be a sponsor, please leave the fields below blank.
Shared Sponsor @ $1,500.00 ea
Hosting Breakfast or a Coffee Break @ $3,000.00 ea
Special Sponsor


$
Please enter your special sponsorship amount above. Please no periods (.) or commas (,)
4. Buffet Luncheon with Vendor Exhibits
If you do not wish to be a vendor exhibitor, please leave the fields below blank.
Vendor Exhibitor (non-Sponsor) @ $1,500.00 ea
Vendor Exhibitor (already a Sponsor – no fee) @ $0.00 ea
5. Events Participation
Please indicate the number of participants.
Is this your first STA Conference? (yes or no)
Monday, October 23rd Welcome Reception & Dinner participants

Tuesday, October 24th Small Agents Info-Social

participants
Wednesday, October 25th Buffet Luncheon with Vendor Exhibits participants
Wednesday, October 25th Open Forum participants
Wednesday, October 25th “Palm Beach Barbeque” participants
6. Golf Tournament on Wednesday, October 26th
Tournament $125 and club rental $50 fees will be billed to your room.
Name of Participant
Handicap
Name of 2nd Participant
Handicap of 2nd Participant
Rent Right Handed Clubs
Rent Left Handed Clubs
No Club Rental
I would like to be paired with the following players:
Player Name 1
Player Name 2
Player Name 3

Total


$0




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If you have any questions or concerns, please contact Carol Gaffney at 732-888-6040  cgaffney@stai.org or John Gaffney at 732-241-8414 jhgaff3@aol.com