CBAO 43rd 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 specify first and last name for additional attendee(s):

4.Convention Badges & Events (please select all that apply) -- we will send you a personalized convention agenda within 5 days of receiving your registration confirmation. (Required.)

FULL CONVENTION BADGE – $659 member / $859 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 / $700 non-member: Available to community bankers whose bank has already purchased a 2017 Full Convention Badge. Each additional attendee after the primary receives a discounted rate.

ONE-DAY CONVENTION BADGE – $450 member / $650 non-member (please indicate whether you prefer TUESDAY or WEDNESDAY in the box below): Includes access to education sessions on Tuesday or Wednesday & that evening’s networking events.

SPOUSE / GUEST FULL CONVENTION BADGE – $400 member / $600 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

STUDENT CONVENTION BADGE – $150 for students currently enrolled in a 2- or 4-year program: Includes access to our Welcome Reception, education sessions, Exhibit Hall Grand Opening, and Silent Auction

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

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

First Name

Last Name

Bank / Company Name

City

Email Address

Phone Number

6.ANNUAL GOLF OUTING RESERVATION AT LEGENDARY RUN GOLF COURSE – $149: 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.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: Monday, July 31

COMMUNITY BANKING SILENT AUCTION & CASINO NIGHT: Tuesday, August 1 at The Westin

CHAIRMAN'S BANQUET: Wednesday, August 2

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

8.Payment Information(Required.)

Invoice Me

Pay with Credit Card

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

9.Credit Card Information

Credit Card Type

Credit Card Number

Expiration Date

Security Code

Name as it Appears on Card

Billing Address for Card

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

Yes

Not Sure