CBAO 44th Annual Convention & Trade Show Registration Survey

1.Personal Information. Please complete the following as you would like it to appear on your badge. (Required.)

First Name:

Last Name:

Title:

Bank / Company Name:

Address:

City:

State:

Postal Code:

Email Address:

Phone Number:

2.Is there a contact you would like your confirmation materials cc'd to?

First Name:

Last Name:

Email Address:

3.Are you registering additional attendees? Please complete the following as their name badge should appear.

Additional Attendee 1 - First & Last Name:

Additional Attendee 1 - Title:

Additional Attendee 1 - Email Address:

Additional Attendee 1 - Phone Number:

Additional Attendee 2 - First & Last Name:

Additional Attendee 2 - Title:

Additional Attendee 2 - Email Address:

Additional Attendee 2 - Phone Number:

Additional Attendee 3 - First & Last Name:

Additional Attendee 3 - Title:

Additional Attendee 3 - Email Address:

Additional Attendee 3 - Phone Number:

4.Convention Badges & Events (please select all that apply)(Required.)

FULL CONVENTION BADGE – $659 member / $959 non-member: Includes access to our Welcome Reception, education sessions, Exhibit Hall Grand Opening, Silent Auction, Community Banking Celebration, Exhibitor Cocktail Hour, & Chairman’s Banquet

SUPPLEMENTARY FULL CONVENTION BADGE – $500 member / $800 non-member: Available to community bankers whose bank has already purchased a 2018 Full Convention Badge. Each additional attendee after the primary receives a discounted rate.

ONE-DAY CONVENTION BADGE – $450 member / $750 non-member (please indicate whether you prefer TUESDAY or WEDNESDAY in the box below): Includes access to education sessions on Wednesday or Thursday & that evening’s networking events.

SPOUSE / GUEST FULL CONVENTION BADGE – $400 member / $700 non-member: Includes access to our Welcome Reception, education sessions, Exhibit Hall Grand Opening, Silent Auction, Community Banking Celebration, Exhibitor Cocktail Hour, and Chairman’s Banquet

If you are purchasing a One-Day Badge, please tell us if you prefer Wednesday or Thursday

5.If you are bringing a spouse/guest, please answer the following for their badge:

First Name

Last Name

City

Email Address

Phone Number

6.ANNUAL GOLF OUTING RESERVATION – $169 members / $199 non-members: Includes (1) round of golf, cart, amenity bag, lunch, adult & non-alcoholic beverages, entry for course contests, and shuttle transportation.(Required.)

I want to participate in the fun - I'm In!

Going to have to miss this year's event

7.If you're registering a guest or additional attendees, will they be golfing?

8.Please RSVP for the Following Evening Networking Events (all events are included in our Full, Supplemental and Spouse/Guest Badges; One-Day Badges include the event(s) on the day of attendance)(Required.)

WELCOME RECEPTION LUAU: Tuesday, July 31

TACOS & TEQUILA COMMUNITY BANKING NIGHT: Wednesday, August 1

CHAIRMAN'S BANQUET HONORING CHAD HOFFMAN: Thursday, August 2

I'm unable to make this year's networking events

9.Payment Information(Required.)

Invoice Me

Pay with Credit Card

Pay with Credit Card Over the Phone (we will contact you within 48 hours)

10.Credit Card Information

Credit Card Type

Credit Card Number

Expiration Date

Security Code

Name as it Appears on Card

Billing Address for Card

12.Are you a member of the Tri State League of Financial Institutions?

Yes

Not Sure