San Antonio Association of Health Underwriters

San Antonio Association of Health Underwriters

<p> 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</p><p>REGISTRATION INFORMATION Name: TDI License #: </p><p>Company Name:</p><p>Address:</p><p>City: State/Zip:</p><p>Phone: Fax:</p><p>E-mail:</p><p>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.</p><p>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.</p><p>Please make checks payable to San Antonio Association of Health Underwriters (SAAHU).</p><p> 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 denise.cecchini@willis.com ADDITIONAL REGISTRANTS</p><p>REGISTRATION INFORMATION #2 Name: TDI License #: </p><p>Phone: Fax:</p><p>E-mail:</p><p>REGISTRATION INFORMATION #3 Name: TDI License #: </p><p>Phone: Fax:</p><p>E-mail:</p><p>REGISTRATION INFORMATION #4 Name: TDI License #: </p><p>Phone: Fax:</p><p>E-mail:</p><p>REGISTRATION INFORMATION #5 Name: TDI License #: </p><p>Phone: Fax:</p><p>E-mail:</p><p>REGISTRATION INFORMATION #6 Name: TDI License #: </p><p>Phone: Fax:</p><p>E-mail:</p><p>REGISTRATION INFORMATION #7 Name: TDI License #: </p><p>Phone: Fax:</p><p>E-mail:</p><p>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:</p><p>E-mail:</p>

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