NATIONAL ASSOCIATION OF STATE FARM AGENTS, INC.

  NASFA Home l Contact NASFA

Register Today for NASFA's 2009 Annual Meeting & Conference

To register for NASFA's 2009 Annual Meeting & Conference, complete the form below and click the submit button.

If you prefer to register by fax or mail, click here to download a registration form.

Spouse/Guest

Agent Registration

Name

Nickname

Check to play in Golf Tournament 

Golf Handicap

Please check if you are entitled to one of these discounts

Platinum Member - $100  Gold Member - $50   Retired Member - $25

Total Agent Registration Fees $

Spouse/Guest Registration

Check here to register a spouse/guest

Name

 Nickname  

Check to play in Golf Tournament 

Golf Handicap

Total Spouse/Guest Registration Fees $

Address

City

  State   Zip

Phone

  Fax

E-mail

Charge $ to my VISA   MasterCard   Amex

Card No.

  CVC No.

Cardholder name

Billing Address   

(if different from above)