Club Members Registration Form

Summer 2010 Seminars

Name
Address
City   State   Zip Code
Phone    Email

I am a member of:
Presidents Club    Ambassadors Club  

Total Number of Attendees

Name(s) of Attendees:

Please indicate which seminar(s) you plan to attend:
     Insurance, August 19, Grand Rapids
     Northern Michigan Seminar, August 26, Gaylord
     Upper Peninsula State Convention, August 27-28, Marquette