21st Annual Professional Development Symposium When: Tuesday, March 6, 2012 Where: Holy Trinity 20523 Huebner Road San Antonio, TX 78258 Time: 8:30 AM – 4:00 PM

REGISTRATION INFORMATION Name: TDI License #:

Company Name:

Address:

City: State/Zip:

Phone: Fax:

E-mail:

REGISTRATION FEES Cost # of Attendees * Subtotal SAAHU Member (Pre-Registration) $75.00 Non-Member $200.00 Employers $75.00 Corporate Table (Seats 8) $500.00 3 or more $450.00 each Booth Sponsor (Includes 2 attendees) $400.00 TOTAL *Please include additional registrant information on page #2.

PAYMENT INFORMATION:  Check  Credit Card * (There is an additional $5.00 processing fee for all credit cards.) Payment must be made in advance. No refunds will be given after February 28, 2012.

Please make checks payable to San Antonio Association of Health Underwriters (SAAHU).

 MasterCard  Visa  Discover  Amex Card Holder Name: ______Billing Address: ______City, State, Zip: ______Phone: ______Amount Charged: ______Card Number: ______Exp. Date: ______VAL Code: ______Signature: ______Date: ______21st Annual Professional Development Symposium When: Tuesday, March 6, 2012 Where: Holy Trinity 20523 Huebner Road San Antonio, TX 78258 Time: 8:30 AM – 4:00 PM Complete all information and return this form and payment via mail or email to: Denise Cecchini – SAAHU Professional Development Chair Willis of Texas, Inc. 1826 North Loop 1604 West, Suite 375 San Antonio TX, 78248 Any questions and/or inquiries can be addressed to: Denise Cecchini at (210) 483-5815 or [email protected] ADDITIONAL REGISTRANTS

REGISTRATION INFORMATION #2 Name: TDI License #:

Phone: Fax:

E-mail:

REGISTRATION INFORMATION #3 Name: TDI License #:

Phone: Fax:

E-mail:

REGISTRATION INFORMATION #4 Name: TDI License #:

Phone: Fax:

E-mail:

REGISTRATION INFORMATION #5 Name: TDI License #:

Phone: Fax:

E-mail:

REGISTRATION INFORMATION #6 Name: TDI License #:

Phone: Fax:

E-mail:

REGISTRATION INFORMATION #7 Name: TDI License #:

Phone: Fax:

E-mail:

REGISTRATION INFORMATION #8 Name: TDI License #: 21st Annual Professional Development Symposium When: Tuesday, March 6, 2012 Where: Holy Trinity 20523 Huebner Road San Antonio, TX 78258 Time: 8:30 AM – 4:00 PM Phone: Fax:

E-mail: